Provider Demographics
NPI:1518121672
Name:GROSS, ROBERT ALVIN (DDS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALVIN
Last Name:GROSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 A THORNBURY LANE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759
Mailing Address - Country:US
Mailing Address - Phone:732-323-0189
Mailing Address - Fax:732-232-0179
Practice Address - Street 1:1251 A THORNBURY LANE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759
Practice Address - Country:US
Practice Address - Phone:732-323-0189
Practice Address - Fax:732-232-0179
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI007796001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice