Provider Demographics
NPI:1275553943
Name:GROSS, ANDREW BRYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BRYAN
Last Name:GROSS
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 1:63 CHESTNUT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1535
Mailing Address - Country:US
Mailing Address - Phone:610-647-4363
Mailing Address - Fax:
Practice Address - Street 1:63 CHESTNUT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1535
Practice Address - Country:US
Practice Address - Phone:610-647-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-024171-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice