Provider Demographics
NPI:1689823635
Name:BOBBY J GROSSI DDS PC
Entity Type:Organization
Organization Name:BOBBY J GROSSI DDS PC
Other - Org Name:GATEWAY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-235-7300
Mailing Address - Street 1:5321 GATEWAY CTR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3980
Mailing Address - Country:US
Mailing Address - Phone:810-235-7300
Mailing Address - Fax:
Practice Address - Street 1:5321 GATEWAY CTR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3980
Practice Address - Country:US
Practice Address - Phone:810-235-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010187751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty