Provider Demographics
NPI:1417961434
Name:DAI, GRACE J (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:J
Last Name:DAI
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 BAILEY LN STE 130
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-8525
Mailing Address - Country:US
Mailing Address - Phone:239-435-0880
Mailing Address - Fax:239-435-0889
Practice Address - Street 1:3200 BAILEY LN STE 130
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-8525
Practice Address - Country:US
Practice Address - Phone:239-435-0880
Practice Address - Fax:239-435-0889
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN99581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics