Provider Demographics
NPI:1598203556
Name:GROVE DENTAL LLC
Entity Type:Organization
Organization Name:GROVE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPONZO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-571-8984
Mailing Address - Street 1:1299 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4302
Mailing Address - Country:US
Mailing Address - Phone:860-571-8984
Mailing Address - Fax:860-529-1509
Practice Address - Street 1:1299 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4302
Practice Address - Country:US
Practice Address - Phone:860-571-8984
Practice Address - Fax:860-529-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty