Healthcare Provider Details

I. General information

NPI: 1073105623
Provider Name (Legal Business Name): GRANVILLE DENTAL - M.ALEXANDRUNAS, D.M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 BROADWAY STE D
GROVE CITY OH
43123-3065
US

IV. Provider business mailing address

4104 BROADWAY STE D
GROVE CITY OH
43123-3065
US

V. Phone/Fax

Practice location:
  • Phone: 614-871-0088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK R. ALEXANDRUNAS
Title or Position: OWNER
Credential:
Phone: 740-587-4891