Provider Demographics
NPI:1881752657
Name:GRAMMATIKAS, ERIC M (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:GRAMMATIKAS
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 1:930 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE #D
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3756
Mailing Address - Country:US
Mailing Address - Phone:909-982-7566
Mailing Address - Fax:909-982-9235
Practice Address - Street 1:930 W FOOTHILL BLVD
Practice Address - Street 2:SUITE #D
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3756
Practice Address - Country:US
Practice Address - Phone:909-982-7566
Practice Address - Fax:909-982-9235
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice