Grenada Dental Clinic Pllc
NPI #1851886857 in Grenada, Mississippi
Provider Information
- NPI Number
- 1851886857
- Entity Type
- Organization
- Organization Name
- Grenada Dental Clinic Pllc
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Jun 22, 2018
- Last Updated
- Jun 22, 2018
Practice Location
- Address
- 1800 HILL DR STE A
- City
- Grenada
- State
- Mississippi
- ZIP Code
- 38901-5071
- Phone
- (662) 226-1757
Authorized Official
- Name
- DR. OLIVIA K VAN GORDON, DMD
- Title
- DENTIST
- Phone
- (662) 226-1757
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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