Provider Demographics
NPI:1023504560
Name:SCHMURA, GRANT JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:JOSEPH
Last Name:SCHMURA
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 1:15875 EMPEROR AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7860
Mailing Address - Country:US
Mailing Address - Phone:651-463-2300
Mailing Address - Fax:
Practice Address - Street 1:15875 EMPEROR AVE STE 100
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7860
Practice Address - Country:US
Practice Address - Phone:651-463-2300
Practice Address - Fax:651-463-2118
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND140301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice