Provider Demographics
NPI:1639621238
Name:GRASSO, ROBIN (RDH)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:GRASSO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10560-1304
Mailing Address - Country:US
Mailing Address - Phone:914-485-1124
Mailing Address - Fax:914-234-6770
Practice Address - Street 1:634 OLD POST RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506-1211
Practice Address - Country:US
Practice Address - Phone:914-234-6632
Practice Address - Fax:914-234-6770
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014857-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist