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NPI Code Detail

MEDICARE: DR. EDWIN DAVID GRANUM D.M.D.

MEDICARE: DR. EDWIN DAVID GRANUM D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry5833OR
21223G0001XGeneral Practice Dentistry8268WA

General Provider Information

NPI Number : 1841369287
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWIN DAVID GRANUM D.M.D.
Provider Business Mailing Address
First Line : 6950 NE CAMPUS WAY
Second Line :
City : HILLSBORO
State : OR
Zip : 97124-5611
Country : US
Telephone Number : 503-952-2164
Fax Number : 503-526-4418
Provider Business Practice Location Address
First Line : 6950 NE CAMPUS WAY
Second Line :
City : HILLSBORO
State : OR
Zip : 97124-5611
Country : US
Telephone Number : 503-952-2164
Fax Number : 503-526-4418
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 05/27/2015

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