Healthcare Provider Details

I. General information

NPI: 1538851118
Provider Name (Legal Business Name): ALAINA GRANIER FRIERSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALAINA ELIZABETH GRANIER DDS

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15382 SAINT CHARLES ST STE A
GULFPORT MS
39503-3122
US

IV. Provider business mailing address

15036 LAURELWOOD DR
GULFPORT MS
39503-8418
US

V. Phone/Fax

Practice location:
  • Phone: 228-832-5300
  • Fax:
Mailing address:
  • Phone: 225-206-4533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4382-23
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: