Provider Demographics
NPI:1891527008
Name:MELISSA GRANT DENTAL CORPORATION
Entity type:Organization
Organization Name:MELISSA GRANT DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-841-2491
Mailing Address - Street 1:3500 N SEPULVEDA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3638
Mailing Address - Country:US
Mailing Address - Phone:310-421-2770
Mailing Address - Fax:
Practice Address - Street 1:3500 N SEPULVEDA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3638
Practice Address - Country:US
Practice Address - Phone:310-421-2770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty