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General NPI Number Information
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NPI Number | 1831163310
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Entity Type | Individual
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Provider Name | BEVERLY ANNETTE GRINSLADE HYGIENIST
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Gender | Female
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2475 GARRISON AVE
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City | PORT ST JOE
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State | FL
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Zip | 32456-5265
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Country | US
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Telephone | 850-227-1276
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Fax |
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Provider Business Mailing Address
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Address Line | 700 TRANSMITTER RD
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City | PANAMA CITY
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State | FL
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Zip | 32401-5394
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Country | US
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Telephone | 850-784-0186
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH12070
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License Number State |
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