Provider Demographics
NPI:1124039417
Name:GROSS, GUY (DDS)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:
Last Name:GROSS
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 1:1920 S OHIO ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6643
Mailing Address - Country:US
Mailing Address - Phone:785-825-7197
Mailing Address - Fax:785-827-9400
Practice Address - Street 1:1920 S OHIO ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-6643
Practice Address - Country:US
Practice Address - Phone:785-825-7197
Practice Address - Fax:785-827-9400
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS601361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice