Provider Demographics
NPI:1144586520
Name:GROH, KENNETH RANDALL (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RANDALL
Last Name:GROH
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 1:336 ALHAMBRA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5004
Mailing Address - Country:US
Mailing Address - Phone:305-442-1177
Mailing Address - Fax:
Practice Address - Street 1:336 ALHAMBRA CIR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5004
Practice Address - Country:US
Practice Address - Phone:305-442-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist