Provider Demographics
NPI:1477311322
Name:GROSS, DENISE L
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LENTHORIA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7300 MOON RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-8335
Mailing Address - Country:US
Mailing Address - Phone:682-371-8289
Mailing Address - Fax:
Practice Address - Street 1:7300 MOON RIDGE CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-8335
Practice Address - Country:US
Practice Address - Phone:682-371-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1474782335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33-1035302OtherNON-SURGICAL HAIR REPLACEMENT