Provider Demographics
NPI:1700858743
Name:GRANDPRE, RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:GRANDPRE
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 1:105 SIERRA MESA PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-4060
Mailing Address - Country:US
Mailing Address - Phone:530-828-4380
Mailing Address - Fax:
Practice Address - Street 1:120 WHITCOMB AVE
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:CA
Practice Address - Zip Code:95713
Practice Address - Country:US
Practice Address - Phone:530-346-6244
Practice Address - Fax:530-346-6001
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist