Provider Demographics
NPI:1245202159
Name:GROSSMAN, LYNDA DENISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:DENISE
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 CAROLINIAN DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-6275
Mailing Address - Country:US
Mailing Address - Phone:843-376-3131
Mailing Address - Fax:
Practice Address - Street 1:198 CAROLINIAN DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-6275
Practice Address - Country:US
Practice Address - Phone:843-376-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0142611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice