Provider Demographics
NPI:1114018348
Name:GROSSER, I. SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:I.
Middle Name:SCOTT
Last Name:GROSSER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-1855
Mailing Address - Country:US
Mailing Address - Phone:330-385-6564
Mailing Address - Fax:740-264-5714
Practice Address - Street 1:1324 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-1855
Practice Address - Country:US
Practice Address - Phone:330-385-6564
Practice Address - Fax:740-264-5714
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0604233Medicaid