Organization
KC GRANGER DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN GRANGER DDS (OWNER)
(301) 249-3333
Entity
Organization
Contact information
Practice address
1211 ENTERPRISE RD, MITCHELLEVILLE, MD 20721-1834
(301) 249-3333
Mailing address
1211 ENTERPRISE RD, BOWIE, MD 20721-1909
(615) 480-5562
(301) 249-4214
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
14112
MD
261QD0000X
Dental Clinic/Center
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39607900
—
MD
Enumeration date
10/19/2010
Last updated
10/25/2023
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