Provider Demographics
NPI:1083299945
Name:NADIA P GROOM DMD PC
Entity Type:Organization
Organization Name:NADIA P GROOM DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:508-255-0557
Mailing Address - Street 1:129 MAIN STREET ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:WEST HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 MAIN STREET ROUTE 28
Practice Address - Street 2:
Practice Address - City:WEST HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02671
Practice Address - Country:US
Practice Address - Phone:508-255-0557
Practice Address - Fax:774-209-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty