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General NPI Number Information
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NPI Number | 1568753366
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Entity Type | Individual
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Provider Name | DR. ELIANA GRADY
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Gender | Female
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 1800 FOREST HILL BLVD STE A3
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-6054
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Country | US
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Telephone | 561-439-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 640 MOONDANCER CT
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-1503
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Country | US
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Telephone |
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19300
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License Number State | FL
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