Provider Demographics
NPI:1578761441
Name:GROPP, KEVIN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:H
Last Name:GROPP
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 1:9241 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3138
Mailing Address - Country:US
Mailing Address - Phone:818-709-8645
Mailing Address - Fax:818-709-8647
Practice Address - Street 1:9241 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3138
Practice Address - Country:US
Practice Address - Phone:818-709-8645
Practice Address - Fax:818-709-8647
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist