Provider Demographics
NPI:1841430345
Name:BAO-THY N. GRANT, D.D.S.,INC.
Entity Type:Organization
Organization Name:BAO-THY N. GRANT, D.D.S.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAO-THY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,INC
Authorized Official - Phone:310-408-8221
Mailing Address - Street 1:1110 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2139
Mailing Address - Country:US
Mailing Address - Phone:714-771-7677
Mailing Address - Fax:714-771-1518
Practice Address - Street 1:1110 E CHAPMAN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2139
Practice Address - Country:US
Practice Address - Phone:714-771-7677
Practice Address - Fax:714-771-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52655261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery