Provider Demographics
NPI:1811268782
Name:MARK R GRENADIER DDS, P.C.
Entity type:Organization
Organization Name:MARK R GRENADIER DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRENADIER
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:412-788-9333
Mailing Address - Street 1:4955 STEUBENVILLE PIKE
Mailing Address - Street 2:#361
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205
Mailing Address - Country:US
Mailing Address - Phone:412-788-9333
Mailing Address - Fax:412-788-9341
Practice Address - Street 1:4955 STEUBENVILLE PIKE
Practice Address - Street 2:#361
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205
Practice Address - Country:US
Practice Address - Phone:412-788-9333
Practice Address - Fax:412-788-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025828-L204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT76347Medicare UPIN