Provider Demographics
NPI:1033639117
Name:ENCALADE, GRANT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
Last Name:ENCALADE
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 1:10601 RANCH ROAD 2222 STE S
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1134
Mailing Address - Country:US
Mailing Address - Phone:512-428-6554
Mailing Address - Fax:
Practice Address - Street 1:10601 RANCH ROAD 2222 STE S
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1134
Practice Address - Country:US
Practice Address - Phone:512-428-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice