Provider Demographics
NPI:1558475152
Name:GROSSMAN, STEVEN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL
Last Name:GROSSMAN
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 1:9433 OLIVE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3132
Mailing Address - Country:US
Mailing Address - Phone:314-993-6706
Mailing Address - Fax:314-993-1263
Practice Address - Street 1:9433 OLIVE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3132
Practice Address - Country:US
Practice Address - Phone:314-993-6706
Practice Address - Fax:314-993-1263
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO133161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice