Provider Demographics
NPI:1932456084
Name:GRANT, THOMAS BRANDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BRANDON
Last Name:GRANT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 PRESTON RD.
Mailing Address - Street 2:BLDG 2, SUITE 200
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:214-436-5122
Mailing Address - Fax:214-436-5118
Practice Address - Street 1:5855 PRESTON RD.
Practice Address - Street 2:BLDG 2, SUITE 200
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:214-436-5122
Practice Address - Fax:214-436-5118
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN199041223G0001X
TX297861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice