Most Relevant Information
Provider Data
| NPI Number: | 1003065988 |
| Provider Name: | MARK GRANT MEDINNUS DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 1223G0001X |
| Specialty: | Dentist |
| License Number: | 33630 |
Most Important Dates
| Enumeration Date: | 09/16/2008 |
| Last Updated: | 03/19/2016 |
Provider Practice Location
9024 SNIKTAW LN
FORT JONES
CA
960329408
Practice Location Phone/Fax
| Phone: | 5304684470 |
| Fax: |
Provider Mailing Location
PO BOX 302
MAD RIVER
CA
955524302
Provider Mailing Phone/Fax
| Phone: | 5304673517 |
| Fax: |