Provider Demographics
NPI:1417336074
Name:GROVE FAMILY DENTAL INC
Entity Type:Organization
Organization Name:GROVE FAMILY DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RITU
Authorized Official - Middle Name:
Authorized Official - Last Name:SETHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-509-0400
Mailing Address - Street 1:129 GROVE STREET
Mailing Address - Street 2:GROVE FAMILY DENTAL
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042
Mailing Address - Country:US
Mailing Address - Phone:973-509-0400
Mailing Address - Fax:973-509-0477
Practice Address - Street 1:129 GROVE STREET
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:973-509-0400
Practice Address - Fax:973-509-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0218316Medicaid