MEDICARE: B. GRIEVE, LLC

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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1639478563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B. GRIEVE, LLC

Provider Business Mailing Address
First Line	:	4425 S PECOS RD
Second Line	:	SUITE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5037
Country	:	US
Telephone Number	:	702-468-7009
Fax Number	:

Provider Business Practice Location Address
First Line	:	4425 S PECOS RD
Second Line	:	SUITE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5037
Country	:	US
Telephone Number	:	702-468-7009
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. BRANDON L GRIEVE
Credential	:	DMD
Telephone Number	:	702-468-7009

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	03/17/2011

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