Provider Demographics
NPI:1437887049
Name:JEREMY M GROVE DDS PLLC
Entity Type:Organization
Organization Name:JEREMY M GROVE DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-725-7511
Mailing Address - Street 1:P.O. BOX 127
Mailing Address - Street 2:501 S BRIDGE ST.
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451
Mailing Address - Country:US
Mailing Address - Phone:810-735-7511
Mailing Address - Fax:810-735-0918
Practice Address - Street 1:501 S BRIDGE ST.
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451
Practice Address - Country:US
Practice Address - Phone:810-735-7511
Practice Address - Fax:810-735-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty