Provider Demographics
NPI:1447405584
Name:COUNTY OF GRANT
Entity Type:Organization
Organization Name:COUNTY OF GRANT
Other - Org Name:GRANT COUNTY HEALTH DEPARTMENT DENTAL PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR / HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KINDRAI
Authorized Official - Suffix:
Authorized Official - Credentials:MSPH, RS
Authorized Official - Phone:608-723-6416
Mailing Address - Street 1:111 S JEFFERSON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-1672
Mailing Address - Country:US
Mailing Address - Phone:608-723-6416
Mailing Address - Fax:608-723-6501
Practice Address - Street 1:111 S JEFFERSON ST FL 2
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-1672
Practice Address - Country:US
Practice Address - Phone:608-723-6416
Practice Address - Fax:608-723-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty