Provider Demographics
NPI:1659382018
Name:MARK S GRENIER DMD PC
Entity Type:Organization
Organization Name:MARK S GRENIER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRENIER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-992-4243
Mailing Address - Street 1:PO BOX 70129
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747
Mailing Address - Country:US
Mailing Address - Phone:508-992-4243
Mailing Address - Fax:508-992-4250
Practice Address - Street 1:78 FAUNCE CORNER RD
Practice Address - Street 2:SUITE 535
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747
Practice Address - Country:US
Practice Address - Phone:508-992-4243
Practice Address - Fax:508-992-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty