Provider Demographics
NPI:1346969631
Name:GROVES, CRAIG LEE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:LEE
Last Name:GROVES
Suffix:JR
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 1:15535 ROSE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-3701
Mailing Address - Country:US
Mailing Address - Phone:408-807-3958
Mailing Address - Fax:
Practice Address - Street 1:810 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4583
Practice Address - Country:US
Practice Address - Phone:813-330-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL274431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice