Provider Demographics
NPI:1629236872
Name:KENNETH E GRINDLAY DDS PC
Entity Type:Organization
Organization Name:KENNETH E GRINDLAY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GRINDLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-482-0026
Mailing Address - Street 1:228 MT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322
Mailing Address - Country:US
Mailing Address - Phone:757-482-0026
Mailing Address - Fax:757-482-0028
Practice Address - Street 1:228 MT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322
Practice Address - Country:US
Practice Address - Phone:757-482-0026
Practice Address - Fax:757-482-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006893122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty