Provider Demographics
NPI:1609947050
Name:GRANTHAM, GARRETT ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:ANDREW
Last Name:GRANTHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 SPRINGHILL MEMORIAL DR N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608
Mailing Address - Country:US
Mailing Address - Phone:251-344-7588
Mailing Address - Fax:251-344-7895
Practice Address - Street 1:3616 SPRINGHILL MEMORIAL DR N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-344-7588
Practice Address - Fax:251-344-7895
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist