| NPI | 1750122644 |
|---|---|
| Doing Business As | GRANDRIDGE DENTAL |
| Entity Type | Organization |
| Authorized Contact | CEMYIRA MCDOUGAL Credentialing Coordinator 217-764-8609 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2024-06-04 |
| Last Update Date | 2024-06-04 |