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General NPI Number Information
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NPI Number | 1023225463
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Entity Type | Individual
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Provider Name | GERALD W. GRINER DDS
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 AVENUE K SE SUITE ONE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-7002
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Country | US
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Telephone | 863-299-2192
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Fax | 863-293-4219
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Provider Business Mailing Address
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Address Line | 200 AVENUE K SE SUITE ONE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-7002
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Country | US
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Telephone | 863-299-2192
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Fax | 863-293-4219
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 06817
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License Number State | FL
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