Provider Demographics
NPI:1548392889
Name:GROSMAN, ALON (D M D)
Entity Type:Individual
Prefix:DR
First Name:ALON
Middle Name:
Last Name:GROSMAN
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 S FLAMINGO RD
Mailing Address - Street 2:STE. 109
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1914
Mailing Address - Country:US
Mailing Address - Phone:954-236-3434
Mailing Address - Fax:954-236-3405
Practice Address - Street 1:5800 N. PARK RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:305-335-5733
Practice Address - Fax:954-986-6989
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics