Organization
SW GRANT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT WILLIAM GRANT DMD (DENTIST)
(208) 938-3190
Entity
Organization
Contact information
Practice address
2275 S EAGLE RD, STE 140, MERIDIAN, ID 83642-5079
(208) 938-3190
(208) 888-1571
Mailing address
2275 S EAGLE RD, STE 140, MERIDIAN, ID 83642-5079
(208) 938-3190
(208) 888-1571
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3981
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6P052
BLUE CROSS
ID
05
—
807480600
—
ID
Enumeration date
04/28/2008
Last updated
09/16/2014
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