Provider Demographics
NPI:1629148770
Name:GROCHMAL, DAVID L (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:GROCHMAL
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 PARADISE MOORINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-6651
Mailing Address - Country:US
Mailing Address - Phone:904-269-9462
Mailing Address - Fax:
Practice Address - Street 1:7740 POINT MEADOWS DR
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9179
Practice Address - Country:US
Practice Address - Phone:904-645-6457
Practice Address - Fax:904-645-6459
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL118181223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health