Provider Demographics
NPI:1831267673
Name:GRIN AND BEAR IT DENTAL CLINIC
Entity type:Organization
Organization Name:GRIN AND BEAR IT DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-254-5477
Mailing Address - Street 1:9513 NE FOURTH PLAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6145
Mailing Address - Country:US
Mailing Address - Phone:360-254-5477
Mailing Address - Fax:360-254-4881
Practice Address - Street 1:9513 NE FOURTH PLAIN ROAD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6145
Practice Address - Country:US
Practice Address - Phone:360-254-5477
Practice Address - Fax:360-254-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAUBI 602-099-7281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty