Provider Demographics
NPI:1336296425
Name:GRANT, CHRISTINE ISOLDE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ISOLDE
Last Name:GRANT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 W SWANN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2533
Mailing Address - Country:US
Mailing Address - Phone:813-251-1548
Mailing Address - Fax:813-251-1077
Practice Address - Street 1:1402 W SWANN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2533
Practice Address - Country:US
Practice Address - Phone:813-251-1548
Practice Address - Fax:813-251-1077
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist