Provider Demographics
NPI:1679654784
Name:GRANGER, JAMES LAWRENCE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LAWRENCE
Last Name:GRANGER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15420 SOUTH HARRELLS FERRY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2940
Mailing Address - Country:US
Mailing Address - Phone:225-753-5885
Mailing Address - Fax:225-753-5908
Practice Address - Street 1:15420 SOUTH HARRELLS FERRY RD
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2940
Practice Address - Country:US
Practice Address - Phone:225-753-5885
Practice Address - Fax:225-753-5908
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist