Individual
LORENDA L. GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
6565 N MACARTHUR BLVD, 225, IRVING, TX 75039-2461
(214) 677-8542
Mailing address
PO BOX 631606, IRVING, TX 75063-0025
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
17194
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-3906587
TAX ID
TX
Enumeration date
05/15/2007
Last updated
05/20/2013
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