Provider Demographics
NPI:1215040365
Name:GRASSO, MICHAEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:GRASSO
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 1:402 TOWNE CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1200
Mailing Address - Country:US
Mailing Address - Phone:732-821-5500
Mailing Address - Fax:732-821-5975
Practice Address - Street 1:402 TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1200
Practice Address - Country:US
Practice Address - Phone:732-821-5500
Practice Address - Fax:732-821-5975
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ132861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice