Provider Demographics
NPI:1336263045
Name:GRANT, MARNIE LOREE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARNIE
Middle Name:LOREE
Last Name:GRANT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1504
Mailing Address - Country:US
Mailing Address - Phone:734-475-1866
Mailing Address - Fax:734-482-9098
Practice Address - Street 1:515 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1504
Practice Address - Country:US
Practice Address - Phone:734-475-1866
Practice Address - Fax:734-475-8505
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI169361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice