Individual
DR. JEREMIAH M. GRANADOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4005 MARKET ST, BEE CAVE, TX 78738-6912
(512) 263-4142
Mailing address
148 DOVER RD, WEST HARTFORD, CT 06119-1214
(954) 410-0247
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
11203
CT
1223E0200X
Endodontics
Primary
37837
TX
390200000X
Student in an Organized Health Care Education/Training Program
11203
CT
Other
Enumeration date
07/04/2014
Last updated
01/10/2022
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