Provider Demographics
NPI:1033130380
Name:DRS. GROSS, MALCMACHER, THALER & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DRS. GROSS, MALCMACHER, THALER & ASSOCIATES, LLC
Other - Org Name:THE HEALTHY SMILE
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,FAGD
Authorized Official - Phone:440-951-7856
Mailing Address - Street 1:34586 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-2002
Mailing Address - Country:US
Mailing Address - Phone:440-951-7856
Mailing Address - Fax:440-946-7878
Practice Address - Street 1:34586 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-2002
Practice Address - Country:US
Practice Address - Phone:440-951-7856
Practice Address - Fax:440-946-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0148381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty