Provider Demographics
NPI:1073708418
Name:GROSSI, SARA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:G
Last Name:GROSSI
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 1:4203 WHITETAIL CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0527
Mailing Address - Country:US
Mailing Address - Phone:252-752-3446
Mailing Address - Fax:
Practice Address - Street 1:4203 WHITETAIL CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0527
Practice Address - Country:US
Practice Address - Phone:252-752-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10193122300000X, 1223P0300X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907748Medicaid
NC2410751Medicare PIN