# GRAND RIVER DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508799594
- **Authorized official:** JAMIE C KISER (OFFICE MANAGER)
- **Authorized official phone:** (435) 313-1302

## Contact information

- **Practice address:** 9500 MENTOR AVE STE 110, MENTOR, OH 44060-8712
- **Practice address phone:** (435) 313-1302
- **Mailing address:** 1034 W JACKSON ST, PAINESVILLE, OH 44077-2529
- **Mailing address phone:** (435) 313-1302

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/08/2026
- **Last updated:** 06/08/2026