Individual
DR. JESSICA JANINA GRUDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
11693 BOYETTE RD, RIVERVIEW, FL 33569-5531
(813) 672-2066
(813) 315-7190
Mailing address
11693 BOYETTE RD, RIVERVIEW, FL 33569-5531
(813) 672-2066
(813) 315-7190
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
30.025113
OH
1223G0001X
General Practice Dentistry
Primary
DN27547
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14089166
CAQH
OH
Enumeration date
08/25/2017
Last updated
11/29/2022
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