MEDICARE: GRANT K PARISH D.D.S.

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
1	1223G0001X	General Practice Dentistry	15074	TX

General Provider Information

NPI Number	:	1851424162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT K PARISH D.D.S.

Provider Business Mailing Address
First Line	:	4222 TRINITY MILLS RD
Second Line	:	SUITE 104
City	:	DALLAS
State	:	TX
Zip	:	75287-7603
Country	:	US
Telephone Number	:	972-250-0900
Fax Number	:	972-250-3798

Provider Business Practice Location Address
First Line	:	4222 TRINITY MILLS RD
Second Line	:	SUITE 104
City	:	DALLAS
State	:	TX
Zip	:	75287-7603
Country	:	US
Telephone Number	:	972-250-0900
Fax Number	:	972-250-3798

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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