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General NPI Number Information
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NPI Number | 1508799594
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Entity Type | Organization
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Legal Business Name | GRAND RIVER DENTAL LLC
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 9500 MENTOR AVE STE 110
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City | MENTOR
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State | OH
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Zip | 44060-8712
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Country | US
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Telephone | 435-313-1302
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 W JACKSON ST
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City | PAINESVILLE
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State | OH
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Zip | 44077-2529
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Country | US
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Telephone | 435-313-1302
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JAMIE C KISER
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Credential |
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Telephone | 435-313-1302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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