Provider Demographics
NPI:1861502213
Name:GRANT FRANCIS DDS PC
Entity Type:Organization
Organization Name:GRANT FRANCIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:H
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-922-1919
Mailing Address - Street 1:943 N LINDER AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-3395
Mailing Address - Country:US
Mailing Address - Phone:208-922-1919
Mailing Address - Fax:208-922-3567
Practice Address - Street 1:943 N LINDER AVE
Practice Address - Street 2:STE 101
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-3395
Practice Address - Country:US
Practice Address - Phone:208-922-1919
Practice Address - Fax:208-922-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID559572OtherUNITED CONCORDIA