Healthcare Provider Details

I. General information

NPI: 1609857531
Provider Name (Legal Business Name): MICHAEL R GRIESMER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6285 YOUNGSTOWN WARREN RD
NILES OH
44446
US

IV. Provider business mailing address

3800 BOARDMAN-CANFIELD RD
CANFIELD OH
44406
US

V. Phone/Fax

Practice location:
  • Phone: 330-505-9224
  • Fax: 330-965-9594
Mailing address:
  • Phone: 330-533-3400
  • Fax: 330-533-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number17887
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: