Provider Demographics
NPI:1447251574
Name:HARTUP, GRANT R (DDS)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:R
Last Name:HARTUP
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 1:8092 PAPER BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-5654
Mailing Address - Country:US
Mailing Address - Phone:703-495-9150
Mailing Address - Fax:
Practice Address - Street 1:HQ USAF/SGCD
Practice Address - Street 2:110 LUKE AVE, ROOM 400
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20032
Practice Address - Country:US
Practice Address - Phone:202-767-4385
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND97401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice