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General NPI Number Information
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NPI Number | 1336698026
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Entity Type | Organization
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Legal Business Name | ANDRE GRENIER DMD, PLLC
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 8200 W SUNRISE BLVD SUITE B1
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City | PLANTATION
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State | FL
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Zip | 33322-5426
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Country | US
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Telephone | 954-473-1806
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Fax | 954-424-6666
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Provider Business Mailing Address
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Address Line | 8200 W SUNRISE BLVD SUITE B1
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City | PLANTATION
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State | FL
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Zip | 33322-5426
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Country | US
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Telephone | 954-473-1806
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Fax | 954-424-6666
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. ANDRE GRENIER
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Credential | DMD
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Telephone | 954-473-1806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN16730
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License Number State | FL
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