Provider Demographics
NPI:1538496716
Name:GROSSO, JEANNE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:J
Last Name:GROSSO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 ERIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-2204
Mailing Address - Country:US
Mailing Address - Phone:518-370-8086
Mailing Address - Fax:518-370-8086
Practice Address - Street 1:139 ERIE BLVD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2204
Practice Address - Country:US
Practice Address - Phone:518-370-8086
Practice Address - Fax:518-370-8086
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0340831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice