Grenada Dental Clinic PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

3934-17 Issued in MS

Legal business name

GRENADA DENTAL CLINIC PLLC

Practice address

1800 Hill Dr Ste a
Grenada, MS 38901-5071

Phone

(662) 226-1757

Fax

(662) 307-2709

NPI assigned

Jun 22, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Olivia K Van Gordon, DMD

Title

Dentist

Phone

(662) 226-1757

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Esaias Steven Richardson, D.D.S.

  • General Practice Dentistry
  • Grenada, MS
  • NPI 1518981844
  NPD (past)
• Olivia McDaniel Van Gordon

  • General Practice Dentistry
  • Grenada, MS
  • NPI 1598285538
  NPD (past)

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

{
    "created_epoch": "1529625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529625600000",
    "number": "1851886857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 HILL DR STE A",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389015071",
            "telephone_number": "662-226-1757",
            "fax_number": "662-307-2709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 HILL DR STE A",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389015071",
            "telephone_number": "662-226-1757",
            "fax_number": "662-307-2709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRENADA DENTAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-22",
        "last_updated": "2018-06-22",
        "status": "A",
        "authorized_official_last_name": "VAN GORDON",
        "authorized_official_first_name": "OLIVIA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "662-226-1757",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MS",
            "license": "3934-17",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grenada Adult Healthcare Clinic PC.
• Grenada Anesthesiology Inc.
• Grenada Cardiology LLC
• Grenada Clinic for Women, PA
• Grenada Dental Associates
• Grenada Diagnostic Radiology
• Grenada Diagnostic Sleep Center, LLC
• Grenada Emergency Group, LLC
• Grenada Family Chiropractic Inc
• Grenada Family Medicine Clinic

• Dental Clinic/Center in Grenada, MS
• Providers in Grenada, MS by specialty
• Dental Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2018; 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.