Provider Demographics
NPI:1518170166
Name:GROFF, JASON PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:GROFF
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 1:2307 SUNSET BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4337
Mailing Address - Country:US
Mailing Address - Phone:916-315-8317
Mailing Address - Fax:916-315-8217
Practice Address - Street 1:2307 SUNSET BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4337
Practice Address - Country:US
Practice Address - Phone:916-315-8317
Practice Address - Fax:916-315-8217
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist