Provider Demographics
NPI:1639434749
Name:GRANT, DEBBIE LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:LYNN
Last Name:GRANT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:LYNN
Other - Last Name:DARIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 8TH AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-764-0000
Mailing Address - Fax:
Practice Address - Street 1:1515 26TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-7707
Practice Address - Country:US
Practice Address - Phone:941-708-7607
Practice Address - Fax:941-708-7618
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19841122300000X, 1223P0221X
MADL13650122300000X
FL19841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist