Provider Demographics
NPI:1558798082
Name:GROUS, STEFANIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEFANIA
Middle Name:
Last Name:GROUS
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 1:1 KNEELAND STREET
Mailing Address - Street 2:12TH FLOOR CLINIC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:857-272-3777
Mailing Address - Fax:617-636-3949
Practice Address - Street 1:1 KNEELAND STREET
Practice Address - Street 2:12TH FLOOR CLINIC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:857-272-3777
Practice Address - Fax:617-636-3949
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL11715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist