Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 2130 | ND |
Y | 1223P0106X | Oral and Maxillofacial Pathology | S48 | MN |
NPI | 1821185844 |
---|---|
Provider Name | Dr. Anupama Grandhi |
First Address | Thief River Falls, MN 56701-4331 |
Second Address | Thief River Falls, MN 56701-4331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 13/09/2012 |