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NPI Code Detail

MEDICARE: DR. JONELLE SENITA GRANT DDS

MEDICARE: DR. JONELLE SENITA GRANT DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist8228NC
21223P0221XPediatric DentistryDEN1000885DC

General Provider Information

NPI Number : 1285704122
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONELLE SENITA GRANT DDS
Provider Business Mailing Address
First Line : 100 I ST SE APT 1117
Second Line :
City : WASHINGTON
State : DC
Zip : 20003-4873
Country : US
Telephone Number : 919-641-2676
Fax Number :
Provider Business Practice Location Address
First Line : 4837 BENNING RD SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-6145
Country : US
Telephone Number : 202-650-5238
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 08/09/2012

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Directions to “ DR. JONELLE SENITA GRANT DDS” Practice Location

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