Provider Demographics
NPI:1447039243
Name:GRANDI DENTAL, INC.
Entity type:Organization
Organization Name:GRANDI DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:720-496-3397
Mailing Address - Street 1:800 MORNING STAR DR STE A
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9260
Mailing Address - Country:US
Mailing Address - Phone:209-532-5788
Mailing Address - Fax:
Practice Address - Street 1:800 MORNING STAR DR STE A
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9260
Practice Address - Country:US
Practice Address - Phone:209-532-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty