Provider Demographics
NPI:1235390022
Name:FRANCIS, GRANT H (DDS)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:H
Last Name:FRANCIS
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 1:943 N LINDER RD
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-3394
Mailing Address - Country:US
Mailing Address - Phone:208-922-1919
Mailing Address - Fax:208-922-3567
Practice Address - Street 1:943 N LINDER RD
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-3394
Practice Address - Country:US
Practice Address - Phone:208-922-1919
Practice Address - Fax:208-922-3567
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805467000Medicaid
ID6C503OtherBLUE CROSS OF IDAHO
ID559572OtherUNITED CONCORDIA