Healthcare Provider Details

I. General information

NPI: 1932181831
Provider Name (Legal Business Name): MARK R GRENADIER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 STEUBENVILLE PIKE #361
PITTSBURGH PA
15205-9619
US

IV. Provider business mailing address

4955 STEUBENVILLE PIKE #361
PITTSBURGH PA
15205-9619
US

V. Phone/Fax

Practice location:
  • Phone: 412-788-9333
  • Fax: 412-788-9341
Mailing address:
  • Phone: 412-788-9333
  • Fax: 412-788-9341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS025828L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: