Provider Demographics
NPI:1578964060
Name:GROSSMAN DDS, INCORPORATED
Entity Type:Organization
Organization Name:GROSSMAN DDS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-674-2720
Mailing Address - Street 1:27569 HOPI SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-6606
Mailing Address - Country:US
Mailing Address - Phone:951-674-2720
Mailing Address - Fax:951-346-3253
Practice Address - Street 1:27569 HOPI SPRINGS CT
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-6606
Practice Address - Country:US
Practice Address - Phone:951-674-2720
Practice Address - Fax:951-346-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty