Provider Demographics
NPI:1144627944
Name:DR. GARY GRINDSTAFF
Entity type:Organization
Organization Name:DR. GARY GRINDSTAFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:GRINDSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-652-5291
Mailing Address - Street 1:1433 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-6539
Mailing Address - Country:US
Mailing Address - Phone:828-652-5291
Mailing Address - Fax:828-659-3512
Practice Address - Street 1:1433 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-6539
Practice Address - Country:US
Practice Address - Phone:828-652-5291
Practice Address - Fax:828-659-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty