Provider Demographics
NPI:1710012943
Name:GRANT, ALIM JAMAL (DDS)
Entity type:Individual
Prefix:DR
First Name:ALIM
Middle Name:JAMAL
Last Name:GRANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 RIDENOUR BLVD NW STE 102
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4486
Mailing Address - Country:US
Mailing Address - Phone:678-273-2819
Mailing Address - Fax:678-245-7162
Practice Address - Street 1:1610 RIDENOUR BLVD NW STE 102
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4486
Practice Address - Country:US
Practice Address - Phone:678-273-2819
Practice Address - Fax:678-245-7162
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012743122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA904873006BMedicaid
GA1487913OtherUNITED CONCORDIA INSURANC