Provider Demographics
NPI:1518419506
Name:GROOVER, LETICIA YVONNE (RDH)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:YVONNE
Last Name:GROOVER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 N. PIEDRAS
Mailing Address - Street 2:U. S. ARMY DENTAL HEALTH ACTIVITY
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-9304
Mailing Address - Fax:
Practice Address - Street 1:5005 N. PIEDRAS
Practice Address - Street 2:U. S. ARMY DENTAL HEALTH ACTIVITY
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12015124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist