Provider Demographics
NPI:1467544213
Name:GROVES, RON D (DDS)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:D
Last Name:GROVES
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 1:2105 W SOUTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6757
Mailing Address - Country:US
Mailing Address - Phone:817-481-2770
Mailing Address - Fax:817-488-5893
Practice Address - Street 1:2105 W SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6757
Practice Address - Country:US
Practice Address - Phone:817-481-2770
Practice Address - Fax:817-488-5893
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics