Provider Demographics
NPI:1396852257
Name:GRANDE, FEDERICO (DDS, MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:
Last Name:GRANDE
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SE INDIAN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5565
Mailing Address - Country:US
Mailing Address - Phone:772-510-5900
Mailing Address - Fax:772-209-6231
Practice Address - Street 1:650 SE INDIAN ST STE 2
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5565
Practice Address - Country:US
Practice Address - Phone:772-510-5900
Practice Address - Fax:772-209-6231
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN148591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI08365Medicare UPIN