Provider Demographics
NPI:1720175763
Name:GRANADOS, JOHN ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:GRANADOS
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 1:27 BLACKSMITH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1870
Mailing Address - Country:US
Mailing Address - Phone:215-968-4400
Mailing Address - Fax:215-968-5673
Practice Address - Street 1:27 BLACKSMITH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1870
Practice Address - Country:US
Practice Address - Phone:215-968-4400
Practice Address - Fax:215-968-5673
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA019471-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice