Provider Demographics
NPI:1528084506
Name:GRANT, DENA G (MD)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:G
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:G
Other - Last Name:UBUILLOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:406 REO ST
Mailing Address - Street 2:220
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-636-2000
Mailing Address - Fax:813-636-2050
Practice Address - Street 1:2550 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:STE B HEALTHPOINT MEDICAL GROUP
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-876-4902
Practice Address - Fax:813-876-0472
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62560208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F66069Medicare UPIN