NPI Profile for ERIC GRANQUIST in PHILADELPHIA, PA.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery | |
Oral and Maxillofacial Surgery |
1223S0112X | 19 | Oral Surgery (Dentist only) |
| NPI Number | 1922291335 |
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| Status | Active | |
| Credentials | DMD (Doctor of Medical Dentistry) | |
| Entity | Individual | |
| Enumeration date | 08/20/2007 | |
| Last updated | 07/25/2023 - About 3 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
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| Hospital affiliation(s) |
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ERIC GRANQUIST
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