Provider Demographics
NPI:1326011578
Name:GROVE AND PLATT DENTAL ASSOCIATES PLC
Entity Type:Organization
Organization Name:GROVE AND PLATT DENTAL ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-986-4001
Mailing Address - Street 1:1541 S THIRD STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111
Mailing Address - Country:US
Mailing Address - Phone:515-986-4001
Mailing Address - Fax:515-986-4037
Practice Address - Street 1:1541 S THIRD STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111
Practice Address - Country:US
Practice Address - Phone:515-986-4001
Practice Address - Fax:515-986-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8358122300000X
IA6772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0470781Medicaid
IA39729OtherWELLMARK BCBS