Provider Demographics
NPI:1740332089
Name:GRIMAUDO, JOSEPH N (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:N
Last Name:GRIMAUDO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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:2007-01-17
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17669332B00000X
FLDN 176691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies