Provider Demographics
NPI:1740627264
Name:GRANT, JAMES EDWARD
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:GRANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 EARLYSTOWN RD
Mailing Address - Street 2:P.O. BOX 197
Mailing Address - City:CENTRE HALL
Mailing Address - State:PA
Mailing Address - Zip Code:16828-9108
Mailing Address - Country:US
Mailing Address - Phone:814-364-9000
Mailing Address - Fax:
Practice Address - Street 1:2837 EARLYSTOWN RD
Practice Address - Street 2:
Practice Address - City:CENTRE HALL
Practice Address - State:PA
Practice Address - Zip Code:16828-9108
Practice Address - Country:US
Practice Address - Phone:814-364-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018139L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist