Organization
BRANDON L GRANTHAM DDS PA
Active
Other names
Cove Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON L GRANTHAM DDS (OWNER)
(254) 547-6453
Entity
Organization
Contact information
Practice address
1801 PATRIOT CIRCLE, COPPERAS COVE, TX 76522
(254) 547-6453
Mailing address
1801 PATRIOT CIRCLE, COPPERAS COVE, TX 76522
(254) 547-6453
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
22297
TX
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1878704
UNITED CONCORDIA
TX
Enumeration date
09/16/2015
Last updated
10/25/2018
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