Provider Demographics
NPI:1568558542
Name:GRANDISON, DAWN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:M
Last Name:GRANDISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 MILLET LN
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-1285
Mailing Address - Country:US
Mailing Address - Phone:302-222-8106
Mailing Address - Fax:668-613-8938
Practice Address - Street 1:773 S QUEEN ST STE B
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3574
Practice Address - Country:US
Practice Address - Phone:302-678-3384
Practice Address - Fax:866-861-3893
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG100011611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001030831Medicaid
DE1000024575Medicaid