Provider Demographics
NPI:1518110915
Name:GRANTHAM, PATRICIA ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 RTE 206
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1532
Mailing Address - Country:US
Mailing Address - Phone:888-289-4603
Mailing Address - Fax:
Practice Address - Street 1:706 RTE 206
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1532
Practice Address - Country:US
Practice Address - Phone:888-289-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1023682001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice