Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | D10078 | WA |
N | 1223P0300X | Periodontist | D7318 | OR |
NPI | 1003936501 |
---|---|
Provider Name | Dr. Melissa Grant |
First Address | Vancouver, WA 98683-5504 |
Second Address | Vancouver, WA 98665-8834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 08/07/2007 |