Provider Demographics
NPI:1235617622
Name:GRASSO, DANTE J (DMD)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:J
Last Name:GRASSO
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:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-0167
Mailing Address - Country:US
Mailing Address - Phone:812-897-3470
Mailing Address - Fax:812-897-0068
Practice Address - Street 1:602 W. LOCUST ST.
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601
Practice Address - Country:US
Practice Address - Phone:812-897-3470
Practice Address - Fax:812-897-0068
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013015A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN753139523OtherDELTA DENTAL
753139523OtherDENTAQUEST
IN753139523OtherDENTAL HEALTH AND WELLNESS
IN753139523OtherHEALTH RESOURCES, INC
IN753139523OtherANTHEM
IN753139523Medicaid
IN753139523OtherUNITED CONCORDIA