Provider Demographics
NPI:1851453997
Name:GROESBECK, ROBERT LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:GROESBECK
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 1:13869 W BELL RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2468
Mailing Address - Country:US
Mailing Address - Phone:623-584-4015
Mailing Address - Fax:
Practice Address - Street 1:13869 W BELL RD
Practice Address - Street 2:STE 103
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2468
Practice Address - Country:US
Practice Address - Phone:623-584-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444051223X0400X
AZ75181223X0400X
TX262061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics