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Individual
DR. GRANT EGNATZ
Active
Individual
DR. GRANT EGNATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901602241
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2901602241
DENTAL LICENSE
MI
01
—
5315251014
CONTROLLED SUBSTANCE LICENSE
MI
Enumeration date
07/01/2024
Last updated
07/01/2024
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