MEDICARE: DR. EDGARDO ARTURO GRANDE D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN 16247	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN 16247	OTHER	FL	STATE DENTAL LICENSE

General Provider Information

NPI Number	:	1063439610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGARDO ARTURO GRANDE D.M.D.

Provider Business Mailing Address
First Line	:	340 ROYAL POINCIANA WAY
Second Line	:	SUITE 309
City	:	PALM BEACH
State	:	FL
Zip	:	33480-4048
Country	:	US
Telephone Number	:	561-832-6647
Fax Number	:	561-832-6828

Provider Business Practice Location Address
First Line	:	340 ROYAL POINCIANA WAY
Second Line	:	SUITE 309
City	:	PALM BEACH
State	:	FL
Zip	:	33480-4048
Country	:	US
Telephone Number	:	561-832-6647
Fax Number	:	561-832-6828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/07/2023

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