Individual
ERIC GRANQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3400 SPRUCE ST, 5TH FLOOR WHITE BLD, PHILADELPHIA, PA 19104-4206
(215) 662-3580
Mailing address
3400 SPRUCE ST, 5TH FLOOR WHITE BLD, PHILADELPHIA, PA 19104-4206
(215) 662-3580
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS036793
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DS036793
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
MD439011
PA
Other
Enumeration date
08/20/2007
Last updated
07/25/2023
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