Provider Demographics
NPI:1487044632
Name:GROSSO, LINDSAY E (DMD, MS,)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:E
Last Name:GROSSO
Suffix:
Gender:F
Credentials:DMD, MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 BARONY ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3145
Mailing Address - Country:US
Mailing Address - Phone:843-899-5800
Mailing Address - Fax:843-899-5806
Practice Address - Street 1:421 BARONY ST STE 6
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3145
Practice Address - Country:US
Practice Address - Phone:843-899-5800
Practice Address - Fax:843-899-5806
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics