Provider Demographics
NPI:1235538323
Name:GRANADO, ROSEANA VIRGINIA
Entity Type:Individual
Prefix:
First Name:ROSEANA
Middle Name:VIRGINIA
Last Name:GRANADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSEANA
Other - Middle Name:VIRGINIA
Other - Last Name:GRANADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:16085 NW HARRIET CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7208
Mailing Address - Country:US
Mailing Address - Phone:909-438-7493
Mailing Address - Fax:
Practice Address - Street 1:16085 NW HARRIET CT
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7208
Practice Address - Country:US
Practice Address - Phone:909-438-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist