Provider Demographics
NPI:1033255609
Name:GRANBERRY, WILLIAM DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:GRANBERRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WEST VETERANS MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548
Mailing Address - Country:US
Mailing Address - Phone:337-643-6400
Mailing Address - Fax:337-643-6401
Practice Address - Street 1:1600 WEST VETERANS MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548
Practice Address - Country:US
Practice Address - Phone:337-643-6400
Practice Address - Fax:337-643-6401
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice