Provider Demographics
NPI:1477858496
Name:GROVE, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GROVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 LAKELAND TRL
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8378
Mailing Address - Country:US
Mailing Address - Phone:803-517-7909
Mailing Address - Fax:
Practice Address - Street 1:1714 LAKELAND TRL
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-8378
Practice Address - Country:US
Practice Address - Phone:803-517-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications