Provider Demographics
NPI:1518317452
Name:GROSLEIB DDS CORPORATION, APC
Entity Type:Organization
Organization Name:GROSLEIB DDS CORPORATION, APC
Other - Org Name:SILVER LAKE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GROSLEIB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-763-8999
Mailing Address - Street 1:12131 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-5054
Mailing Address - Country:US
Mailing Address - Phone:818-763-8999
Mailing Address - Fax:
Practice Address - Street 1:2815 SUNSET BLVD., SUITE 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2168
Practice Address - Country:US
Practice Address - Phone:213-380-2008
Practice Address - Fax:213-484-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental