Provider Demographics
NPI:1760652804
Name:GRINIS, ASTA ELENA (DDS)
Entity Type:Individual
Prefix:
First Name:ASTA
Middle Name:ELENA
Last Name:GRINIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8351 BLIND PASS RD
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706
Mailing Address - Country:US
Mailing Address - Phone:727-363-6169
Mailing Address - Fax:727-363-6997
Practice Address - Street 1:8351 BLIND PASS RD
Practice Address - Street 2:
Practice Address - City:ST PETE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33706
Practice Address - Country:US
Practice Address - Phone:727-363-6169
Practice Address - Fax:727-363-6997
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN96161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice