Provider Demographics
NPI:1922078393
Name:GRIDER, JAMIE ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ALAN
Last Name:GRIDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2863 OLD FORT PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-4418
Mailing Address - Country:US
Mailing Address - Phone:615-867-1735
Mailing Address - Fax:
Practice Address - Street 1:2863 OLD FORT PKWY STE C
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4418
Practice Address - Country:US
Practice Address - Phone:615-867-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126831223G0001X
TNDS00000084311223G0001X
TN8431332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1223G0001XDental ProvidersDentistGeneral Practice