Individual
DR. STEPHANIE L. GRIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
6080 LUTE RD, PORTAGE, IN 46368-5008
(219) 763-6646
(219) 762-8763
Mailing address
6080 LUTE RD, PORTAGE, IN 46368-5008
(219) 763-6646
(219) 762-8763
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019030285
IL
122300000X
Dentist
Primary
1201823A
IN
122300000X
Dentist
2901022447
MI
Other
Enumeration date
07/15/2015
Last updated
01/25/2022
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