| Kenneth Grundset Pa | |
|
9634 107th Ave N Largo FL 33773-4503 | |
| (727) 851-6870 | |
| Not Available |
| Full Name | Kenneth Grundset Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 9634 107th Ave N, Largo, Florida |
| Authorized Official Name and Position | Kenneth Grundest (OWNER) |
| Authorized Official Contact | 7272821970 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth Grundset Pa 9634 107th Ave N Largo FL 33773-4503 Ph: (727) 851-6870 | Kenneth Grundset Pa 9634 107th Ave N Largo FL 33773-4503 Ph: (727) 851-6870 |
| NPI Number | 1699185298 |
|---|---|
| Provider Enumeration Date | 05/05/2014 |
| Last Update Date | 11/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699185298 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN 04596 (Florida) | Primary |
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