Provider Demographics
NPI:1043681836
Name:GROSMAN PEDIATRIC DENTISTRY AND ORTHODONTICS
Entity Type:Organization
Organization Name:GROSMAN PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRANZINI-GROSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-236-3434
Mailing Address - Street 1:4401 S FLAMINGO RD
Mailing Address - Street 2:STE 109
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1914
Mailing Address - Country:US
Mailing Address - Phone:954-236-3434
Mailing Address - Fax:954-236-3405
Practice Address - Street 1:4401 S FLAMINGO RD
Practice Address - Street 2:STE 109
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-1914
Practice Address - Country:US
Practice Address - Phone:954-236-3434
Practice Address - Fax:954-236-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 152031223P0221X
FLDN208261223P0221X
FLD156641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1740354174OtherINDIVIDUAL NPI
FL1427345057OtherINDIVIDUAL NPI
FL1548392889OtherINDIVIDUAL NPI