Provider Demographics
NPI:1932181831
Name:GRENADIER, MARK R (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:GRENADIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 STEUBENVILLE PIKE
Mailing Address - Street 2:#361
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-9619
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:15205-9619
Practice Address - Country:US
Practice Address - Phone:412-788-9333
Practice Address - Fax:412-788-9341
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025828L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA429777Medicare ID - Type Unspecified