Provider Demographics
NPI:1578766945
Name:GROSS, CONRAD PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:PETER
Last Name:GROSS
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 1:26 CANTERBURY WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-3871
Mailing Address - Country:US
Mailing Address - Phone:732-751-1395
Mailing Address - Fax:
Practice Address - Street 1:4205 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3308
Practice Address - Country:US
Practice Address - Phone:732-370-8640
Practice Address - Fax:732-370-7923
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0154181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice