# GRIN PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144720103
- **Authorized official:** DR. JAMES G DRAKE DMD (DOCTOR/PARTNER)
- **Authorized official phone:** (208) 524-0870

## Contact information

- **Practice address:** 2685 CHANNING WAY, IDAHO FALLS, ID 83404-7518
- **Practice address phone:** (208) 522-1164
- **Mailing address:** 885 PANCHERI DR, IDAHO FALLS, ID 83402-3344
- **Mailing address phone:** (208) 524-0870
- **Mailing address fax:** (208) 524-0873

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1989 | ID | — |
| 1223G0001X | General Practice Dentistry | D3203 | ID | — |
| 1223G0001X | General Practice Dentistry | D3723 | ID | Yes |

## Other

- **Enumeration date:** 02/16/2018
- **Last updated:** 02/16/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000886878 | UNITED CONCORDIA | — |
| 01 | — | 001493204 | UNITED CONCORDIA | — |
| 01 | — | 6C016 | BLUE CROSS OF IDAHO | ID |
| 01 | — | 6K158 | BLUE CROSS OF IDAHO | ID |