Individual
JASON GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
416 4TH ST, FAIRBURY, NE 68352-2514
(402) 729-6177
Mailing address
416 4TH ST, FAIRBURY, NE 68352-2514
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7085
NE
Other
Enumeration date
05/30/2013
Last updated
05/30/2013
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