Provider Demographics
NPI:1164615092
Name:GROVER, ROBERT W (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:GROVER
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 1:38 SUNTREE PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7604
Mailing Address - Country:US
Mailing Address - Phone:321-259-9511
Mailing Address - Fax:321-255-4644
Practice Address - Street 1:38 SUNTREE PL
Practice Address - Street 2:SUITE 1
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7604
Practice Address - Country:US
Practice Address - Phone:321-259-9511
Practice Address - Fax:321-255-4644
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice