Provider Demographics
NPI:1316561392
Name:HADFIELD, GRASON JOSEPH (DMD)
Entity Type:Individual
Prefix:
First Name:GRASON
Middle Name:JOSEPH
Last Name:HADFIELD
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 1:2940 W WAGONER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-1122
Mailing Address - Country:US
Mailing Address - Phone:208-870-1778
Mailing Address - Fax:
Practice Address - Street 1:283 BLVD DE FRANCE
Practice Address - Street 2:
Practice Address - City:PARRIS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29906
Practice Address - Country:US
Practice Address - Phone:208-870-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-51411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice