Provider Demographics
NPI:1649418377
Name:KEVIN C. GRANGER, D.D.S., P.C.
Entity Type:Organization
Organization Name:KEVIN C. GRANGER, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-790-5533
Mailing Address - Street 1:8363B GREENSBORO DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3530
Mailing Address - Country:US
Mailing Address - Phone:703-790-5533
Mailing Address - Fax:703-556-9760
Practice Address - Street 1:8363B GREENSBORO DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3530
Practice Address - Country:US
Practice Address - Phone:703-790-5533
Practice Address - Fax:703-556-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty