Individual
GRACE SETIAWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5115 N GALLOWAY AVE STE 301, MESQUITE, TX 75150-7535
(972) 686-6477
(972) 613-7504
Mailing address
5115 N GALLOWAY AVE STE 301, MESQUITE, TX 75150-7535
(972) 686-6477
(972) 613-7504
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
23899
TX
Other
Enumeration date
10/24/2008
Last updated
03/21/2011
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