Provider Demographics
NPI:1225744840
Name:GRANT, GELYN YONIQUEA
Entity Type:Individual
Prefix:
First Name:GELYN
Middle Name:YONIQUEA
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 ACTON RD
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:SC
Mailing Address - Zip Code:29040-9629
Mailing Address - Country:US
Mailing Address - Phone:347-707-3701
Mailing Address - Fax:
Practice Address - Street 1:51 MEDIACL GROUP
Practice Address - Street 2:777 SONGTAN BLVD
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96278
Practice Address - Country:US
Practice Address - Phone:315-748-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant