Provider Demographics
NPI:1568420834
Name:GROSSMAN, ROBERT HENRY (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HENRY
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 NICOLLET AVE
Mailing Address - Street 2:STE. 301
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5710
Mailing Address - Country:US
Mailing Address - Phone:952-435-4131
Mailing Address - Fax:952-435-4158
Practice Address - Street 1:14050 NICOLLET AVE
Practice Address - Street 2:STE 301
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5710
Practice Address - Country:US
Practice Address - Phone:952-435-4131
Practice Address - Fax:952-435-4158
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics