Organization
GRENADA DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GINGER PAYNE (OFFICE)
(662) 226-6014
Entity
Organization
Contact information
Practice address
2117 COMMERCE ST, GRENADA, MS 38901-5400
(662) 226-6014
(662) 226-9986
Mailing address
2117 COMMERCE ST, GRENADA, MS 38901-5400
(662) 226-6014
(662) 226-9986
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1896-80
MS
1223G0001X
General Practice Dentistry
1912-80
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467572206
BCBS
MS
01
—
1619018462
BCBS
MS
Enumeration date
08/12/2008
Last updated
08/12/2008
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