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General NPI Number Information
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NPI Number | 1659382018
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Entity Type | Organization
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Legal Business Name | MARK S GRENIER DMD PC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 12/28/2012
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Provider Practice Location Address
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Address Line | 78 FAUNCE CORNER RD SUITE 535
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City | N DARTMOUTH
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State | MA
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Zip | 02747
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Country | US
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Telephone | 508-992-4243
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Fax | 508-992-4250
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Provider Business Mailing Address
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Address Line | PO BOX 70129
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City | N DARTMOUTH
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State | MA
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Zip | 02747
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Country | US
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Telephone | 508-992-4243
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Fax | 508-992-4250
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK S GRENIER
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Credential | DMD
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Telephone | 508-992-4243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14933
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License Number State | MA
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