1255408928 NPI number — DR. ANDREW SCOTT GRIVAS III DDS

Table of content: DR. ANDREW SCOTT GRIVAS III DDS (NPI 1255408928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255408928 NPI number — DR. ANDREW SCOTT GRIVAS III DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIVAS
Provider First Name:
ANDREW
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255408928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 SCRIPPS DR
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-929-9222
Provider Business Mailing Address Fax Number:
916-929-5848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 SCRIPPS DR
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-6207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-929-9222
Provider Business Practice Location Address Fax Number:
916-929-5848
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  52726 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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