Individual
RICHARD GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.,M.S.
Contact information
Practice address
12395 EL CAMINO REAL, SUITE 218, SAN DIEGO, CA 92130-3082
(858) 755-1515
(858) 755-7878
Mailing address
12374 CARMEL COUNTRY RD, H310, SAN DIEGO, CA 92130-4523
(858) 205-3872
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
51412
CA
Other
Enumeration date
02/06/2007
Last updated
07/08/2007
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