Provider Demographics
NPI:1235375551
Name:NIGEL D. GRANDISON, DMD
Entity Type:Organization
Organization Name:NIGEL D. GRANDISON, DMD
Other - Org Name:KIDS CARE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRANDISON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-432-1607
Mailing Address - Street 1:10117 CLEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1066
Mailing Address - Country:US
Mailing Address - Phone:954-916-9060
Mailing Address - Fax:954-916-9063
Practice Address - Street 1:10117 CLEARY BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1066
Practice Address - Country:US
Practice Address - Phone:954-916-9060
Practice Address - Fax:954-916-9063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL144461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty