Provider Demographics
NPI:1194002840
Name:GROSSMAN, RONALD MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MARK
Last Name:GROSSMAN
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 1:6525 BELCREST RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2003
Mailing Address - Country:US
Mailing Address - Phone:301-927-2900
Mailing Address - Fax:301-927-2747
Practice Address - Street 1:6525 BELCREST RD
Practice Address - Street 2:SUITE 212
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2003
Practice Address - Country:US
Practice Address - Phone:301-927-2900
Practice Address - Fax:301-927-2747
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6978122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist