Provider Demographics
NPI:1083621692
Name:GILES, GRANT EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:EUGENE
Last Name:GILES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4214 ANDREWS HWY STE 307
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4869
Mailing Address - Country:US
Mailing Address - Phone:432-522-3546
Mailing Address - Fax:432-522-1882
Practice Address - Street 1:4214 ANDREWS HWY STE 307
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4869
Practice Address - Country:US
Practice Address - Phone:432-522-3546
Practice Address - Fax:432-522-1882
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics