Provider Demographics
NPI:1225607971
Name:SITTASON, GRAYSON BLAIR (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRAYSON
Middle Name:BLAIR
Last Name:SITTASON
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 1:804 PENN CIR SE
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-3308
Mailing Address - Country:US
Mailing Address - Phone:256-466-0623
Mailing Address - Fax:
Practice Address - Street 1:819 HIGHWAY 31 NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-4412
Practice Address - Country:US
Practice Address - Phone:256-773-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006914-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice