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 1:4041 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2401
Mailing Address - Country:US
Mailing Address - Phone:941-326-4273
Mailing Address - Fax:941-229-8598
Practice Address - Street 1:4041 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2401
Practice Address - Country:US
Practice Address - Phone:786-514-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL13650122300000X
FLDN19841122300000X, 1223P0221X
FL19841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist