Provider Demographics
NPI:1316505902
Name:GRANIGAN, MARLIA SANDRA (DMD)
Entity type:Individual
Prefix:
First Name:MARLIA
Middle Name:SANDRA
Last Name:GRANIGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MONCRIEF RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1528
Mailing Address - Country:US
Mailing Address - Phone:781-974-8694
Mailing Address - Fax:
Practice Address - Street 1:64 MONCRIEF RD
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-1528
Practice Address - Country:US
Practice Address - Phone:781-974-8694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA00000000OtherDMD