Provider Demographics
NPI:1346371648
Name:JERRY GROSS DDS PA
Entity Type:Organization
Organization Name:JERRY GROSS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-279-2311
Mailing Address - Street 1:152 MARKET ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1724
Mailing Address - Country:US
Mailing Address - Phone:973-279-2311
Mailing Address - Fax:973-279-4623
Practice Address - Street 1:152 MARKET ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1724
Practice Address - Country:US
Practice Address - Phone:973-279-2311
Practice Address - Fax:973-279-4623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0168561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty