Provider Demographics
NPI:1720416613
Name:GROSS, BRIAN HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HOWARD
Last Name:GROSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 BERACASA WAY
Mailing Address - Street 2:SUITE101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3453
Mailing Address - Country:US
Mailing Address - Phone:561-338-6411
Mailing Address - Fax:561-368-9949
Practice Address - Street 1:7015 BERACASA WAY
Practice Address - Street 2:SUITE101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3453
Practice Address - Country:US
Practice Address - Phone:561-338-6411
Practice Address - Fax:561-368-9949
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist