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NPI Code Detail

MEDICARE: GRANT LONNEMAN

MEDICARE: GRANT LONNEMAN
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
11223G0001XGeneral Practice Dentistry11419SC

General Provider Information

NPI Number : 1932045143
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRANT LONNEMAN
Provider Business Mailing Address
First Line : 2146 VESPERS DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-6240
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1859 SAVAGE RD
Second Line :
City : CHARLESTON
State : SC
Zip : 29407-4726
Country : US
Telephone Number : 843-722-5733
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2026
Last Update Date : 05/19/2026

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Directions to “ GRANT LONNEMAN ” Practice Location

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