Individual
GRACE ISHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
9200 113TH ST, SEMINOLE, FL 33772-2800
(727) 893-5050
Mailing address
2616 DERBY GLEN DR, LUTZ, FL 33559-2006
(813) 325-1310
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DRPM2745
FL
Other
Enumeration date
06/12/2024
Last updated
06/12/2024
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