Organization
DOCTORS OF DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN C GRANETO DMD (PRES)
(623) 931-3794
Entity
Organization
Contact information
Practice address
5945 W BETHANY HOME RD, GLENDALE, AZ 85301-5104
(623) 931-3794
(623) 931-2567
Mailing address
17809 N 55TH PL, SCOTTSDALE, AZ 85254-5841
(602) 971-0791
(623) 931-2567
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3883
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130724
AHCCCS
AZ
Enumeration date
10/20/2006
Last updated
04/10/2010
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