Individual
DR. THOMAS GRANDVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
8 MEDICAL DR, PORT JEFFERSON STATION, NY 11776-1601
(631) 928-8585
Mailing address
8 MEDICAL DR, PORT JEFFERSON STATION, NY 11776-1601
(631) 928-8585
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
056816
NY
Other
Enumeration date
06/09/2011
Last updated
04/19/2017
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