| NPI | 1770750028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG A GRANDGENETT Owner/President 515-956-3426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 07931) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 07946) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2008-05-14 |