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Individual
ERIC GRANQUIST
Active
Individual
ERIC GRANQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS036793
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DS036793
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
MD439011
PA
Other
Enumeration date
08/20/2007
Last updated
07/25/2023
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