Provider Demographics
NPI:1326213893
Name:BOICE, GRANT EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:EDWIN
Last Name:BOICE
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 1:10901 FOLSOM BLVD
Mailing Address - Street 2:STE. F
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-5162
Mailing Address - Country:US
Mailing Address - Phone:916-635-2062
Mailing Address - Fax:916-635-5582
Practice Address - Street 1:10901 FOLSOM BLVD
Practice Address - Street 2:STE. F
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5162
Practice Address - Country:US
Practice Address - Phone:916-635-2062
Practice Address - Fax:916-635-5582
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist