Provider Demographics
NPI:1174180426
Name:GROSSMAN, STEPHANIE (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
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:UNIVERSITY OF DETROIT MERCY SCHOOL OF DENTISTRY
Mailing Address - Street 2:2700 MARTIN LUTHER KING JR. BLVD
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF DETROIT MERCY SCHOOL OF DENTISTRY
Practice Address - Street 2:2700 MARTIN LUTHER KING JR. BLVD
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2576
Practice Address - Country:US
Practice Address - Phone:313-494-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program