Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2901018520 | MI |
NPI | 1063527695 |
---|---|
Provider Name | Dr. Theodore Roberts Grigg |
First Address | Saginaw, MI 48638-7189 |
Second Address | Saginaw, MI 48638-7189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |