Individual
JILLIAN MARY GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
27005 76TH AVE, NEW HYDE PARK, NY 11040-1496
(718) 470-3076
Mailing address
27005 76TH AVE, NEW HYDE PARK, NY 11040-1496
(718) 470-3076
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
06229701
NY
Other
Enumeration date
02/12/2020
Last updated
10/16/2023
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