Provider Demographics
NPI:1093836363
Name:GRIAS, THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:GRIAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:THANASIS
Other - Middle Name:
Other - Last Name:GRIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9363 CHERRY VALLEY AVE SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9506
Mailing Address - Country:US
Mailing Address - Phone:616-891-8990
Mailing Address - Fax:616-891-9004
Practice Address - Street 1:9363 CHERRY VALLEY AVE SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-9506
Practice Address - Country:US
Practice Address - Phone:616-891-8990
Practice Address - Fax:616-891-9004
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice