Individual
DR. STEPHEN B GRANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
465 MEMORIAL DRIVE, POCATELLO, ID 83209-0000
(208) 282-3289
(208) 282-5834
Mailing address
465 MEMORIAL DR, POCATELLO, ID 83209-0001
(208) 282-3289
(208) 282-5834
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-4593
ID
Other
Enumeration date
06/27/2014
Last updated
03/07/2023
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