Provider Demographics
NPI:1982648119
Name:GRANT-GUESS, ANDREA RENEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:RENEE
Last Name:GRANT-GUESS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:RENEE
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:35 TIMBER MARSH LN
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2369
Mailing Address - Country:US
Mailing Address - Phone:843-342-3890
Mailing Address - Fax:
Practice Address - Street 1:300 NEW RIVER PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4450
Practice Address - Country:US
Practice Address - Phone:843-208-2888
Practice Address - Fax:888-239-7509
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC 4081ZXMedicaid