# SW GRANT PC

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

## Provider details

- **NPI number:** 1881869055
- **Authorized official:** DR. SCOTT WILLIAM GRANT DMD (DENTIST)
- **Authorized official phone:** (208) 938-3190

## Contact information

- **Practice address:** 2275 S EAGLE RD, STE 140, MERIDIAN, ID 83642-5079
- **Practice address phone:** (208) 938-3190
- **Practice address fax:** (208) 888-1571
- **Mailing address:** 2275 S EAGLE RD, STE 140, MERIDIAN, ID 83642-5079
- **Mailing address phone:** (208) 938-3190
- **Mailing address fax:** (208) 888-1571

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D-3981 | ID | Yes |

## Other

- **Enumeration date:** 04/28/2008
- **Last updated:** 09/16/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6P052 | BLUE CROSS | ID |
| 05 | — | 807480600 | — | ID |