Provider Demographics
NPI:1740306802
Name:COLLING, GRANT ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:ROBERT
Last Name:COLLING
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 1:124 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2217
Mailing Address - Country:US
Mailing Address - Phone:218-736-5627
Mailing Address - Fax:218-736-6955
Practice Address - Street 1:124 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2217
Practice Address - Country:US
Practice Address - Phone:218-736-5627
Practice Address - Fax:218-736-6955
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND91781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice