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Individual

SCOTT WILLIAM GRANT

Active
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Individual

SCOTT WILLIAM GRANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-3981
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010157447
BLUE SHIELD
ID
01
—
00001890338
UNITED CONCORDIA
ID
01
—
6P052
BLUE CROSS
ID
05
—
807480600
—
ID
Enumeration date
11/15/2006
Last updated
07/29/2014
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