Individual
GRACE K LAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3250 ZEMKE AVE, TAMPA, FL 33621-5023
(813) 827-9400
Mailing address
6814 S HESPERIDES ST, TAMPA, FL 33616-2536
(954) 294-8860
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH22658
FL
Other
Enumeration date
02/12/2016
Last updated
02/12/2016
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