Provider Demographics
NPI:1326196023
Name:GROVE, DALE W (DMD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:W
Last Name:GROVE
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 1:1286 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2130
Mailing Address - Country:US
Mailing Address - Phone:610-372-8406
Mailing Address - Fax:610-372-3998
Practice Address - Street 1:1286 PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2130
Practice Address - Country:US
Practice Address - Phone:610-372-8406
Practice Address - Fax:610-372-3998
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017881L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA159883OtherUNITED CONCORDIA PROVIDER