MEDICARE: DR. CHRISTINE ISOLDE GRANT D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN13279	FL

General Provider Information

NPI Number	:	1336296425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE ISOLDE GRANT D.M.D.

Provider Business Mailing Address
First Line	:	1402 W SWANN AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2533
Country	:	US
Telephone Number	:	813-251-1548
Fax Number	:	813-251-1077

Provider Business Practice Location Address
First Line	:	1402 W SWANN AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2533
Country	:	US
Telephone Number	:	813-251-1548
Fax Number	:	813-251-1077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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