Provider Demographics
NPI:1689763245
Name:GROSS, RICHARD G (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:GROSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1261
Mailing Address - Country:US
Mailing Address - Phone:610-524-9530
Mailing Address - Fax:610-524-6585
Practice Address - Street 1:601 GORDON DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1261
Practice Address - Country:US
Practice Address - Phone:610-524-9530
Practice Address - Fax:610-524-6585
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0360831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice