Provider Demographics
NPI:1538256110
Name:GRANDER, JAMES WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:GRANDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NORTH ASH
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061
Mailing Address - Country:US
Mailing Address - Phone:830-334-3333
Mailing Address - Fax:830-334-3307
Practice Address - Street 1:111 NORTH ASH
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061
Practice Address - Country:US
Practice Address - Phone:830-334-3333
Practice Address - Fax:830-334-3307
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist