Provider Demographics
NPI:1134265382
Name:GRANT, CHARLOTTE ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:ELIZABETH
Last Name:GRANT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10910 KINGSTON PIKE UNIT 105
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2948
Mailing Address - Country:US
Mailing Address - Phone:865-218-9177
Mailing Address - Fax:
Practice Address - Street 1:10910 KINGSTON PIKE UNIT 105
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2948
Practice Address - Country:US
Practice Address - Phone:865-218-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000121501223P0221X
TN121501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0221XDental ProvidersDentistPediatric Dentistry