Provider Demographics
NPI:1073642559
Name:GRANDGEORGE, MONTE F (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONTE
Middle Name:F
Last Name:GRANDGEORGE
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 1:310 E CALL ST
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-2417
Mailing Address - Country:US
Mailing Address - Phone:515-295-2334
Mailing Address - Fax:515-395-2334
Practice Address - Street 1:310 E CALL ST
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-2417
Practice Address - Country:US
Practice Address - Phone:515-295-2334
Practice Address - Fax:515-395-2334
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA61341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice