Provider Demographics
NPI:1730104175
Name:SMITH, GRANT ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:ROBERT
Last Name:SMITH
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 1:3700 W 83RD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5121
Mailing Address - Country:US
Mailing Address - Phone:913-649-5600
Mailing Address - Fax:913-649-2069
Practice Address - Street 1:3700 W 83RD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5121
Practice Address - Country:US
Practice Address - Phone:913-649-5600
Practice Address - Fax:913-649-2069
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS601551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice