Provider Demographics
NPI:1174690432
Name:QUAYLE, GRANT O (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:O
Last Name:QUAYLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 E FORT UNION BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047
Mailing Address - Country:US
Mailing Address - Phone:801-676-8100
Mailing Address - Fax:801-569-2317
Practice Address - Street 1:1275 E FORT UNION BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047
Practice Address - Country:US
Practice Address - Phone:801-676-8100
Practice Address - Fax:801-569-2317
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT138403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist