Provider Demographics
NPI:1144382342
Name:GRIDER, JOSEPH A IV (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:GRIDER
Suffix:IV
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 1:202 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4211
Mailing Address - Country:US
Mailing Address - Phone:765-529-9180
Mailing Address - Fax:765-529-7442
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4211
Practice Address - Country:US
Practice Address - Phone:765-529-9180
Practice Address - Fax:765-529-7442
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN6498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100134580AMedicaid
IN100134580AMedicaid