Organization
GRANT AND PHAM DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD GRANT (OWNER)
(858) 205-3872
Entity
Organization
Contact information
Practice address
9710 WINTER GARDENS BLVD, LAKESIDE, CA 92040-3866
(619) 443-8447
Mailing address
9710 WINTER GARDENS BLVD, LAKESIDE, CA 92040-3866
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
52916
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
51412
CA
Other
Enumeration date
06/22/2009
Last updated
07/13/2009
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