Provider Demographics
NPI:1497711667
Name:GROVER, JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:GROVER
Suffix:
Gender:F
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:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-0548
Mailing Address - Country:US
Mailing Address - Phone:517-784-3950
Mailing Address - Fax:517-783-2728
Practice Address - Street 1:817 W HIGH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2986
Practice Address - Country:US
Practice Address - Phone:517-784-3985
Practice Address - Fax:517-787-0852
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010121561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice