| Granville Dental, Llc | |
|
100 N Mccoy St Granville IL 61326-9329 | |
| (815) 339-6888 | |
| Not Available |
| Full Name | Granville Dental, Llc |
|---|---|
| Speciality | Dentist |
| Location | 100 N Mccoy St, Granville, Illinois |
| Authorized Official Name and Position | Robert Dawe (OWNER) |
| Authorized Official Contact | 8153396888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Granville Dental, Llc 100 N Mccoy St Granville IL 61326-9329 Ph: (815) 339-6888 | Granville Dental, Llc 100 N Mccoy St Granville IL 61326-9329 Ph: (815) 339-6888 |
| NPI Number | 1821536368 |
|---|---|
| Provider Enumeration Date | 02/04/2017 |
| Last Update Date | 02/04/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821536368 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019016044 (Illinois) | Primary |