Provider Demographics
NPI:1063039766
Name:GRISHIN, NADIA T (DDS)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:T
Last Name:GRISHIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2253
Mailing Address - Country:US
Mailing Address - Phone:509-475-0350
Mailing Address - Fax:
Practice Address - Street 1:1915 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2253
Practice Address - Country:US
Practice Address - Phone:509-475-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATP610855891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1223G0001XDental ProvidersDentistGeneral Practice