Provider Demographics
NPI:1831280098
Name:ROBERT A GROLLMAN DDS PC
Entity Type:Organization
Organization Name:ROBERT A GROLLMAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:GROLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-475-3432
Mailing Address - Street 1:160 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1623
Mailing Address - Country:US
Mailing Address - Phone:770-475-3432
Mailing Address - Fax:770-475-4019
Practice Address - Street 1:160 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-1623
Practice Address - Country:US
Practice Address - Phone:770-475-3432
Practice Address - Fax:770-475-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN007173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty