Provider Demographics
NPI:1013355643
Name:WEST, GRAYSON T (DDS)
Entity type:Individual
Prefix:DR
First Name:GRAYSON
Middle Name:T
Last Name:WEST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 15TH ST NW
Mailing Address - Street 2:STE. C
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-5594
Mailing Address - Country:US
Mailing Address - Phone:651-631-3100
Mailing Address - Fax:651-631-1728
Practice Address - Street 1:2459 15TH ST NW
Practice Address - Street 2:STE. C
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-5594
Practice Address - Country:US
Practice Address - Phone:651-631-3100
Practice Address - Fax:651-631-1728
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist