Provider Demographics
NPI:1851372056
Name:GROSSHEIM, RALPH ERNEST JR (DDS)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:ERNEST
Last Name:GROSSHEIM
Suffix:JR
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 1:1001 OLD HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-7720
Mailing Address - Country:US
Mailing Address - Phone:931-381-7667
Mailing Address - Fax:
Practice Address - Street 1:51 SMITH AVE
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-1124
Practice Address - Country:US
Practice Address - Phone:931-796-2204
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND57680122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist