| 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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John H. Coleman,pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1162 S Line St, Grenada, MS 38901 Phone: 662-226-0585 Fax: 662-226-0586 |