Provider Demographics
NPI:1932328101
Name:GRINER, CLAIRE DORNBUSCH (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:DORNBUSCH
Last Name:GRINER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COVENTRY CV
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8480
Mailing Address - Country:US
Mailing Address - Phone:601-856-5751
Mailing Address - Fax:
Practice Address - Street 1:100 COVENTRY CV
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8480
Practice Address - Country:US
Practice Address - Phone:601-856-5751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3395-06122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist