Provider Demographics
NPI:1871667667
Name:GRIMAUDO, MELISSA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:GRIMAUDO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17200 CAMELOT CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7202
Mailing Address - Country:US
Mailing Address - Phone:813-345-8580
Mailing Address - Fax:813-345-8581
Practice Address - Street 1:17200 CAMELOT CT
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7202
Practice Address - Country:US
Practice Address - Phone:813-345-8580
Practice Address - Fax:813-345-8581
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17542332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies