Provider Demographics
NPI:1689781296
Name:GROVER, WILLIAM MICHAEL (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:GROVER
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 LANCASTER DR.
Mailing Address - Street 2:STE. 101
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-0000
Mailing Address - Country:US
Mailing Address - Phone:817-481-1622
Mailing Address - Fax:817-251-0319
Practice Address - Street 1:1602 LANCASTER DR.
Practice Address - Street 2:STE. 101
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-0000
Practice Address - Country:US
Practice Address - Phone:817-481-1622
Practice Address - Fax:817-251-0319
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics