Provider Demographics
NPI:1285011569
Name:NATHAN J. GRANILLO, DDS, INC.
Entity Type:Organization
Organization Name:NATHAN J. GRANILLO, DDS, INC.
Other - Org Name:HEMET VALLEY ORTHODONTICS/HEMET CHILDRENS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRANILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:951-652-2234
Mailing Address - Street 1:1630 EL NITA LN
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4657
Mailing Address - Country:US
Mailing Address - Phone:951-652-2234
Mailing Address - Fax:951-652-5894
Practice Address - Street 1:1630 EL NITA LN
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4657
Practice Address - Country:US
Practice Address - Phone:951-652-2234
Practice Address - Fax:951-652-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563311223P0221X
CA590121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty