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Organization
GRENADA DENTAL CLINIC PLLC
Active
Organization
GRENADA DENTAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLIVIA K VAN GORDON DMD (DENTIST)
(662) 226-1757
Entity
Organization
Contact information
Practice address
1800 HILL DR STE A, GRENADA, MS 38901-5071
(662) 226-1757
(662) 307-2709
Mailing address
1800 HILL DR STE A, GRENADA, MS 38901-5071
(662) 226-1757
(662) 307-2709
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3934-17
MS
Other
Enumeration date
06/22/2018
Last updated
06/22/2018
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