Grenada Dental Clinic Pllc | |
1800 Hill Dr Ste A Grenada MS 38901-5071 | |
(662) 226-1757 | |
(662) 307-2709 |
Full Name | Grenada Dental Clinic Pllc |
---|---|
Speciality | Clinic/center - Dental |
Location | 1800 Hill Dr Ste A, Grenada, Mississippi |
Authorized Official Name and Position | Olivia K Van Gordon (DENTIST) |
Authorized Official Contact | 6622261757 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Grenada Dental Clinic Pllc 1800 Hill Dr Ste A Grenada MS 38901-5071 Ph: (662) 226-1757 | Grenada Dental Clinic Pllc 1800 Hill Dr Ste A Grenada MS 38901-5071 Ph: (662) 226-1757 |
NPI Number | 1851886857 |
---|---|
Provider Enumeration Date | 06/22/2018 |
Last Update Date | 06/22/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851886857 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | 3934-17 (Mississippi) | Primary |
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