Provider Demographics
NPI:1326127531
Name:GRANT, HELEN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:T
Last Name:GRANT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 SICKLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2916
Mailing Address - Country:US
Mailing Address - Phone:845-536-3606
Mailing Address - Fax:845-358-1444
Practice Address - Street 1:175 SICKLETOWN RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2916
Practice Address - Country:US
Practice Address - Phone:845-536-3606
Practice Address - Fax:845-358-1444
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0450661223G0001X
NJ190391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477398Medicaid