Provider Demographics
NPI:1013137827
Name:GRN, NAMNINDER S (DMD)
Entity Type:Individual
Prefix:MR
First Name:NAMNINDER
Middle Name:S
Last Name:GRN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1677 E FLORENCE BLVD
Mailing Address - Street 2:#24
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222
Mailing Address - Country:US
Mailing Address - Phone:520-836-5466
Mailing Address - Fax:520-836-7469
Practice Address - Street 1:1677 E FLORENCE BLVD
Practice Address - Street 2:#24
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:520-836-5466
Practice Address - Fax:520-836-7469
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist