Provider Demographics
NPI:1477624559
Name:GROSSMAN, SPENCER JARED (DMD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:JARED
Last Name:GROSSMAN
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 1:55 DELEVAN ST
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530-2011
Mailing Address - Country:US
Mailing Address - Phone:609-397-0366
Mailing Address - Fax:
Practice Address - Street 1:338 GEORGES RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1546
Practice Address - Country:US
Practice Address - Phone:732-329-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02260300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist