Provider Demographics
NPI:1063816247
Name:KATHERINE A GRIGG DDS PA
Entity Type:Organization
Organization Name:KATHERINE A GRIGG DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRIGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-544-5085
Mailing Address - Street 1:598 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-2728
Mailing Address - Country:US
Mailing Address - Phone:828-765-9002
Mailing Address - Fax:828-765-1614
Practice Address - Street 1:598 OAK AVE
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-2728
Practice Address - Country:US
Practice Address - Phone:828-765-9002
Practice Address - Fax:828-765-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7837302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization