Provider Demographics
NPI:1083835318
Name:GRIGG, A EDWARDS (DDS)
Entity Type:Individual
Prefix:DR
First Name:A
Middle Name:EDWARDS
Last Name:GRIGG
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 1:5481 COLONY DR N
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7189
Mailing Address - Country:US
Mailing Address - Phone:989-792-8888
Mailing Address - Fax:989-792-4002
Practice Address - Street 1:5481 COLONY DR N
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7189
Practice Address - Country:US
Practice Address - Phone:989-792-8888
Practice Address - Fax:989-792-4002
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI09619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist