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Individual

BEVERLY ANNETTE GRINSLADE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
HYGIENIST

Contact information

Practice address
2475 GARRISON AVE, PORT ST JOE, FL 32456-5265
(850) 227-1276
Mailing address
700 TRANSMITTER RD, PANAMA CITY, FL 32401-5394
(850) 784-0186

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH12070

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DH 12070
HYGIENIST
Enumeration date
02/14/2006
Last updated
07/08/2007
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