Provider Demographics
NPI:1588205330
Name:LAI, GRANT CAMERON (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:CAMERON
Last Name:LAI
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 1:456 MONTGOMERY ST STE GC-3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-1233
Mailing Address - Country:US
Mailing Address - Phone:415-391-9000
Mailing Address - Fax:415-391-9019
Practice Address - Street 1:456 MONTGOMERY ST STE GC-3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-1233
Practice Address - Country:US
Practice Address - Phone:415-391-9000
Practice Address - Fax:415-391-9019
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1040971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty