Organization Name: | PAUL G. GRANDSIRE, DMD, PLLC |
NPI Number: | 1285923599 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAUL GRANDSIRE (OWNER) |
Mailing Address: | 1415 Boston Post Rd Larchmont |
State: | NY US |
Postal Code: | 105383935 |
Phone Number: | 9148341646 |
Fax Number: | 9148338335 |
NPI Enumeration Date: | 04/07/2011 |
NPI Last Update Date: | 04/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 036185 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |