Provider Demographics
NPI:1497834923
Name:SHIMIZU, GRANT F (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:F
Last Name:SHIMIZU
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 1:2664 BERRYESSA RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2925
Mailing Address - Country:US
Mailing Address - Phone:408-923-5511
Mailing Address - Fax:408-923-7389
Practice Address - Street 1:2664 BERRYESSA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2925
Practice Address - Country:US
Practice Address - Phone:408-923-5511
Practice Address - Fax:408-923-7389
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice