Provider Demographics
NPI:1700358231
Name:JUST FOR GRINS, PC
Entity type:Organization
Organization Name:JUST FOR GRINS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:276-494-0508
Mailing Address - Street 1:1941 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3607
Mailing Address - Country:US
Mailing Address - Phone:276-494-0508
Mailing Address - Fax:276-494-0508
Practice Address - Street 1:1941 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3607
Practice Address - Country:US
Practice Address - Phone:276-494-0508
Practice Address - Fax:276-494-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty