Individual
KEVIN C. GRANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2415 BENNING RD NE, WASHINGTON, DC 20002-4827
(202) 396-9679
(202) 396-9773
Mailing address
8363B GREENSBORO DR, MC LEAN, VA 22102-3530
(615) 480-5562
(703) 556-9760
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401411967
VA
122300000X
Dentist
14112
MD
122300000X
Dentist
T22045
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039607900
—
MD
05
—
049045800
—
DC
05
—
051370400
—
DC
05
—
170550101
—
TX
Enumeration date
12/22/2005
Last updated
06/29/2016
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