Provider Demographics
NPI:1649657321
Name:GRISHIN, INNA
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:GRISHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:INNA
Other - Middle Name:
Other - Last Name:GRISHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:14534 BRACKNEY LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7742
Mailing Address - Country:US
Mailing Address - Phone:317-650-3942
Mailing Address - Fax:
Practice Address - Street 1:14534 BRACKNEY LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7742
Practice Address - Country:US
Practice Address - Phone:317-650-3942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist