Olivia Mcdaniel Van Gordon
NPI #1598285538 in Grenada, Mississippi
Provider Information
- NPI Number
- 1598285538
- Entity Type
- Individual
- Name
- Olivia Mcdaniel Van Gordon
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Jun 21, 2017
- Last Updated
- Jul 21, 2022
Practice Location
- Address
- 1800 F S HILL DR STE A
- City
- Grenada
- State
- Mississippi
- ZIP Code
- 38901-5071
- Phone
- (662) 226-1757
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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