Provider Demographics
NPI:1912164062
Name:MCGANN, GRANT BENSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:BENSON
Last Name:MCGANN
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 1:7910 FROST ST
Mailing Address - Street 2:#310
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-874-8181
Mailing Address - Fax:858-429-7010
Practice Address - Street 1:7910 FROST ST
Practice Address - Street 2:#310
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-874-8181
Practice Address - Fax:858-429-7010
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery