Provider Demographics
NPI:1346136520
Name:RENAISSANCE DENTAL STUDIO, INC.
Entity type:Organization
Organization Name:RENAISSANCE DENTAL STUDIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-821-3855
Mailing Address - Street 1:1419 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5607
Mailing Address - Country:US
Mailing Address - Phone:318-821-3855
Mailing Address - Fax:
Practice Address - Street 1:1419 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5607
Practice Address - Country:US
Practice Address - Phone:318-322-5904
Practice Address - Fax:318-322-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental