Provider Demographics
NPI:1740173871
Name:GRANTHAM, BRODY (DDS)
Entity type:Individual
Prefix:
First Name:BRODY
Middle Name:
Last Name:GRANTHAM
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 1:1155 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1202
Mailing Address - Country:US
Mailing Address - Phone:605-882-3060
Mailing Address - Fax:605-882-0681
Practice Address - Street 1:1155 4TH ST NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1202
Practice Address - Country:US
Practice Address - Phone:605-882-3060
Practice Address - Fax:605-882-0681
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist