Provider Demographics
NPI:1134301872
Name:GROOTERS, BENJAMIN JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JAMES
Last Name:GROOTERS
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 1:1305 THOMASWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7915
Mailing Address - Country:US
Mailing Address - Phone:850-386-2400
Mailing Address - Fax:850-386-8181
Practice Address - Street 1:1318 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6506
Practice Address - Country:US
Practice Address - Phone:850-877-0215
Practice Address - Fax:850-942-4310
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist