Provider Demographics
NPI:1326129255
Name:L. MARK GROSS, DDS, PA
Entity Type:Organization
Organization Name:L. MARK GROSS, DDS, PA
Other - Org Name:L. MARK GROSS, DDS, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-986-8804
Mailing Address - Street 1:4702 CHEVY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6433
Mailing Address - Country:US
Mailing Address - Phone:301-986-8804
Mailing Address - Fax:301-229-5751
Practice Address - Street 1:4702 CHEVY CHASE DR
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6433
Practice Address - Country:US
Practice Address - Phone:301-986-8804
Practice Address - Fax:301-229-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD55521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty