Individual
DR. GRANT EGNATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1011 N UNIVERSITY AVE, ANN ARBOR, MI 48109-1078
(734) 764-1568
Mailing address
609 W MADISON ST, ANN ARBOR, MI 48103-4927
(336) 413-9742
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901602241
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2901602241
DENTAL LICENSE
MI
01
—
5315251014
CONTROLLED SUBSTANCE LICENSE
MI
Enumeration date
07/01/2024
Last updated
07/01/2024
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