Provider Demographics
NPI:1073503587
Name:GRASSO, MICHAEL F (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:GRASSO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WEST DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1843
Mailing Address - Country:US
Mailing Address - Phone:636-777-7700
Mailing Address - Fax:636-777-4415
Practice Address - Street 1:2 WEST DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-1843
Practice Address - Country:US
Practice Address - Phone:636-777-7700
Practice Address - Fax:636-777-4415
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO141531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice