Provider Demographics
NPI:1417995952
Name:GROVER, NORMAN EUGENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:EUGENE
Last Name:GROVER
Suffix:
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 1:414 W JAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-1219
Mailing Address - Country:US
Mailing Address - Phone:573-265-8402
Mailing Address - Fax:573-265-8802
Practice Address - Street 1:414 W JAMES BLVD
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-1219
Practice Address - Country:US
Practice Address - Phone:573-265-8402
Practice Address - Fax:573-265-8802
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO126441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107482OtherBC BS FEDERAL
MO527045OtherUNITED CONCORDIA