Provider Demographics
NPI:1659723252
Name:GRENIER, ANN-MARIE
Entity Type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:
Last Name:GRENIER
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 1:254 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:S PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2410
Mailing Address - Country:US
Mailing Address - Phone:207-774-5527
Mailing Address - Fax:
Practice Address - Street 1:254 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:S PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2410
Practice Address - Country:US
Practice Address - Phone:207-774-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME65124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist