Provider Demographics
NPI:1366612954
Name:GRANT, BAO-THY NGOC (DDS)
Entity type:Individual
Prefix:DR
First Name:BAO-THY
Middle Name:NGOC
Last Name:GRANT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1110 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2139
Mailing Address - Country:US
Mailing Address - Phone:714-771-7677
Mailing Address - Fax:714-771-1518
Practice Address - Street 1:1110 E CHAPMAN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2139
Practice Address - Country:US
Practice Address - Phone:714-771-7677
Practice Address - Fax:714-771-1518
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery