Provider Demographics
NPI:1689852477
Name:M TODD GROOMS DDS PA
Entity Type:Organization
Organization Name:M TODD GROOMS DDS PA
Other - Org Name:ALAMANCE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-227-5444
Mailing Address - Street 1:306 ALAMANCE RD STE C
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5684
Mailing Address - Country:US
Mailing Address - Phone:336-227-5444
Mailing Address - Fax:336-227-0029
Practice Address - Street 1:306 ALAMANCE RD
Practice Address - Street 2:STE C
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5684
Practice Address - Country:US
Practice Address - Phone:336-227-5444
Practice Address - Fax:336-227-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty