Individual
GRANT QUAN LOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
224 BASTON RD, MARTINEZ, GA 30907-2976
(706) 868-1722
(706) 868-9516
Mailing address
224 BASTON RD, MARTINEZ, GA 30907-2976
(706) 868-1722
(706) 868-9516
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10962
GA
Other
Enumeration date
12/22/2006
Last updated
07/11/2012
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