Provider Demographics
NPI:1912180571
Name:GRANVILLE DENTAL MARK ALEXANDRUNAS DMD INC
Entity Type:Organization
Organization Name:GRANVILLE DENTAL MARK ALEXANDRUNAS DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ALEXANDRUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:614-425-9061
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0286
Mailing Address - Country:US
Mailing Address - Phone:740-587-4891
Mailing Address - Fax:
Practice Address - Street 1:121 BROADWAY E
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1303
Practice Address - Country:US
Practice Address - Phone:740-587-4891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty