Provider Demographics
NPI:1538851118
Name:FRIERSON, ALAINA GRANIER (DDS)
Entity type:Individual
Prefix:
First Name:ALAINA
Middle Name:GRANIER
Last Name:FRIERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALAINA
Other - Middle Name:ELIZABETH
Other - Last Name:GRANIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:15036 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-8418
Mailing Address - Country:US
Mailing Address - Phone:225-206-4533
Mailing Address - Fax:
Practice Address - Street 1:15382 SAINT CHARLES ST STE A
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3122
Practice Address - Country:US
Practice Address - Phone:228-832-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS4382-231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program