Provider Demographics
NPI:1720696198
Name:GRANT, SEDERIC (DDS)
Entity Type:Individual
Prefix:
First Name:SEDERIC
Middle Name:
Last Name:GRANT
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 1:18580 VIA PRINCESSA STE 3
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-8329
Mailing Address - Country:US
Mailing Address - Phone:661-388-0499
Mailing Address - Fax:
Practice Address - Street 1:18580 VIA PRINCESSA STE 3
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387-8329
Practice Address - Country:US
Practice Address - Phone:661-388-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR7831223P0221X
CADDS1076351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry