Provider Demographics
NPI:1619718996
Name:GRANIER, JAMIE LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:GRANIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 HIGHWAY 652
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-2332
Mailing Address - Country:US
Mailing Address - Phone:985-413-0170
Mailing Address - Fax:
Practice Address - Street 1:109 JOHNNY DUFRENE DR
Practice Address - Street 2:
Practice Address - City:MATHEWS
Practice Address - State:LA
Practice Address - Zip Code:70375
Practice Address - Country:US
Practice Address - Phone:985-532-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA75561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice