Provider Demographics
NPI:1760378871
Name:GRANT FAMILY DENTISTRY
Entity type:Organization
Organization Name:GRANT FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-201-7026
Mailing Address - Street 1:225 EAGLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:RANGELY
Mailing Address - State:CO
Mailing Address - Zip Code:81648-3105
Mailing Address - Country:US
Mailing Address - Phone:970-272-1712
Mailing Address - Fax:970-272-1726
Practice Address - Street 1:225 EAGLE CREST DR
Practice Address - Street 2:
Practice Address - City:RANGELY
Practice Address - State:CO
Practice Address - Zip Code:81648-3105
Practice Address - Country:US
Practice Address - Phone:970-272-1712
Practice Address - Fax:970-272-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty