Provider Demographics
NPI:1063030856
Name:GROH, HANNAH ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:ELIZABETH
Last Name:GROH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 S LAMAR BLVD APT 213
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8098
Mailing Address - Country:US
Mailing Address - Phone:317-213-7439
Mailing Address - Fax:
Practice Address - Street 1:6104 S 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4052
Practice Address - Country:US
Practice Address - Phone:512-222-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX386741223G0001X
IL019.032656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist