Provider Demographics
NPI:1376700708
Name:GROENEVELD, ERIC P (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:P
Last Name:GROENEVELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68720 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-1295
Mailing Address - Country:US
Mailing Address - Phone:586-727-0990
Mailing Address - Fax:586-727-4872
Practice Address - Street 1:68720 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1295
Practice Address - Country:US
Practice Address - Phone:586-727-0990
Practice Address - Fax:586-727-4872
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist