MEDICARE: DR. MARK R GRENADIER 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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS025828L	PA

General Provider Information

NPI Number	:	1932181831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK R GRENADIER DDS

Provider Business Mailing Address
First Line	:	4955 STEUBENVILLE PIKE
Second Line	:	#361
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-9619
Country	:	US
Telephone Number	:	412-788-9333
Fax Number	:	412-788-9341

Provider Business Practice Location Address
First Line	:	4955 STEUBENVILLE PIKE
Second Line	:	#361
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-9619
Country	:	US
Telephone Number	:	412-788-9333
Fax Number	:	412-788-9341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/02/2010

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