Provider Demographics
NPI:1386831576
Name:GROVER, SURENDER SHEETAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SURENDER
Middle Name:SHEETAL
Last Name:GROVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 E MARKET ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1727
Mailing Address - Country:US
Mailing Address - Phone:845-379-0996
Mailing Address - Fax:845-876-8357
Practice Address - Street 1:187 E MARKET ST
Practice Address - Street 2:SUITE 300
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1727
Practice Address - Country:US
Practice Address - Phone:845-379-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055292122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist