Provider Demographics
NPI:1114930559
Name:GROSSMAN, STEPHEN H (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:GROSSMAN
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 1:77 GREAT ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720
Mailing Address - Country:US
Mailing Address - Phone:978-263-1313
Mailing Address - Fax:978-264-4440
Practice Address - Street 1:77 GREAT ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720
Practice Address - Country:US
Practice Address - Phone:978-263-1313
Practice Address - Fax:978-264-4440
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA145791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics