Provider Demographics
NPI:1841286861
Name:GRANDY, DENNIS WAYNE (DPM)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WAYNE
Last Name:GRANDY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:87 SCRIPPS DR STE 306
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6318
Mailing Address - Country:US
Mailing Address - Phone:916-920-0371
Mailing Address - Fax:916-920-8533
Practice Address - Street 1:3939 J ST
Practice Address - Street 2:SUITE 270
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3631
Practice Address - Country:US
Practice Address - Phone:916-454-3668
Practice Address - Fax:916-454-9255
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3293213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E32930Medicaid
CAT11616Medicare UPIN
3662100001Medicare NSC