Individual
SCOTT WILLIAM GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2275 S EAGLE RD STE 140, MERIDIAN, ID 83642-2620
(208) 938-3190
Mailing address
2275 S EAGLE RD STE 140, MERIDIAN, ID 83642-2620
(208) 938-3190
(208) 888-1571
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-3981
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010157447
BLUE SHIELD
ID
01
—
00001890338
UNITED CONCORDIA
ID
01
—
6P052
BLUE CROSS
ID
05
—
807480600
—
ID
Enumeration date
11/15/2006
Last updated
07/29/2014
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