Healthcare Provider Details

I. General information

NPI: 1336698026
Provider Name (Legal Business Name): ANDRE GRENIER DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 W SUNRISE BLVD SUITE B1
PLANTATION FL
33322-5426
US

IV. Provider business mailing address

8200 W SUNRISE BLVD SUITE B1
PLANTATION FL
33322-5426
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-1806
  • Fax: 954-424-6666
Mailing address:
  • Phone: 954-473-1806
  • Fax: 954-424-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN16730
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANDRE GRENIER
Title or Position: DOCTOR/OWNER
Credential: DMD
Phone: 954-473-1806