Healthcare Provider Details

I. General information

NPI: 1952416869
Provider Name (Legal Business Name): RODGER LANCE GRISSETT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19748 S GREENO RD
FAIRHOPE AL
36532
US

IV. Provider business mailing address

19748 S GREENO RD
FAIRHOPE AL
36532
US

V. Phone/Fax

Practice location:
  • Phone: 251-990-5959
  • Fax: 251-990-8268
Mailing address:
  • Phone: 251-990-5959
  • Fax: 251-990-8268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberAL4925
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberAL4925
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: