Provider Demographics
NPI:1104861822
Name:SERVICE, GRANT H (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:H
Last Name:SERVICE
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 1:2711 N DUKE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2619
Mailing Address - Country:US
Mailing Address - Phone:919-220-6553
Mailing Address - Fax:919-220-2682
Practice Address - Street 1:2711 N DUKE ST
Practice Address - Street 2:SUITE B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2619
Practice Address - Country:US
Practice Address - Phone:919-220-6553
Practice Address - Fax:919-220-2682
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice