Provider Demographics
NPI:1487865622
Name:GRANT, BARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:GRANT
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 1:73219 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4701
Mailing Address - Country:US
Mailing Address - Phone:760-346-6543
Mailing Address - Fax:760-406-6109
Practice Address - Street 1:73219 JUNIPER ST
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4701
Practice Address - Country:US
Practice Address - Phone:760-346-6543
Practice Address - Fax:760-406-6109
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice