Individual
MAGGIE GRISSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7489 PARKER RD, FAIRHOPE, AL 36532-3320
(251) 928-9292
Mailing address
8423 BLUEGATE CT, HOUSTON, TX 77025-3213
(256) 343-6604
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-0006868-C1
AL
Other
Enumeration date
05/13/2021
Last updated
05/13/2021
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