Provider Demographics
NPI:1407261837
Name:GRANT DENTAL CARE PC
Entity Type:Organization
Organization Name:GRANT DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-582-5920
Mailing Address - Street 1:P.O. BOX 1035
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976
Mailing Address - Country:US
Mailing Address - Phone:256-582-5920
Mailing Address - Fax:
Practice Address - Street 1:114 EMMETT AYERS ROAD
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:AL
Practice Address - Zip Code:35747
Practice Address - Country:US
Practice Address - Phone:256-728-2231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty