MEDICARE: DR. RICHARD A GRANT D.D.S. P.A.

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	10509	FL

General Provider Information

NPI Number	:	1568588226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A GRANT D.D.S. P.A.

Provider Business Mailing Address
First Line	:	20215 NW 2ND AVE
Second Line	:	SUITE # 2
City	:	MIAMI
State	:	FL
Zip	:	33169-2538
Country	:	US
Telephone Number	:	305-652-3001
Fax Number	:	305-652-3048

Provider Business Practice Location Address
First Line	:	20215 NW 2ND AVE
Second Line	:	SUITE # 2
City	:	MIAMI
State	:	FL
Zip	:	33169-2538
Country	:	US
Telephone Number	:	305-652-3001
Fax Number	:	305-652-3048

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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