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General NPI Number Information
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NPI Number | 1083524938
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Entity Type | Organization
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Legal Business Name | GULF GRINS LLC
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Dates
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Enumeration Date | 09/11/2026
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Last Update Date | 09/11/2026
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Provider Practice Location Address
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Address Line | 24700 US HIGHWAY 331 S STE 100
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-5502
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Country | US
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Telephone | 850-931-8750
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Fax |
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Provider Business Mailing Address
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Address Line | 24700 US HIGHWAY 331 S STE 100
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-5502
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Country | US
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Telephone | 850-931-8750
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | LAUREN DIXON SIMON SEJAN
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Credential | DMD, MS
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Telephone | 850-931-8750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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