# GREGORY P GRANTHAM DMD PA

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

## Provider details

- **NPI number:** 1477714384
- **Authorized official:** DR. GREGORY P GRANTHAM DMD (OWNER/PHYSICIAN)
- **Authorized official phone:** (850) 769-3253

## Contact information

- **Practice address:** 340 W 23RD ST, SUITE A, PANAMA CITY, FL 32405-7600
- **Practice address phone:** (850) 769-3253
- **Practice address fax:** (850) 784-0057
- **Mailing address:** 340 W 23RD ST, SUITE A, PANAMA CITY, FL 32405-7600
- **Mailing address phone:** (850) 769-3253
- **Mailing address fax:** (850) 784-0057

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DN4098 | FL | Yes |

## Other

- **Enumeration date:** 06/23/2008
- **Last updated:** 06/23/2008