Healthcare Provider Details

I. General information

NPI: 1427361526
Provider Name (Legal Business Name): VICTORIA GRADY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2010
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 DR PHILLIPS BLVD
ORLANDO FL
32819-3312
US

IV. Provider business mailing address

3101 BAYSHORE BLVD UNIT 2302
TAMPA FL
33629-8151
US

V. Phone/Fax

Practice location:
  • Phone: 407-326-0240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN22877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: