Organization Active NPI

Grand River Dental LLC

  • Dental Clinic/Center
  • Mentor, OH
National Provider Identifier
1508799594
Registry record updated Jun 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
GRAND RIVER DENTAL LLC
Practice address
9500 Mentor Ave Ste 110
Mentor, OH 44060-8712
Phone
(435) 313-1302
NPI assigned
Jun 8, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jamie C Kiser
Title
Office Manager
Phone
(435) 313-1302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

9500 Mentor Ave Ste 110
Mentor, OH 44060-8712

Mailing address

1034 W Jackson St
Painesville, OH 44077-2529
Phone (435) 313-1302

National Provider Directory

National Provider Directory

Locations

9500 Mentor Ave
Ste 110
Mentor, OH 44060
Phone (440) 354-2363

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1780876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780876800000",
    "number": "1508799594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 W JACKSON ST",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "440772529",
            "telephone_number": "435-313-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 MENTOR AVE STE 110",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608712",
            "telephone_number": "435-313-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND RIVER DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-08",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-01",
        "status": "A",
        "authorized_official_last_name": "KISER",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "435-313-1302"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.