Provider Demographics
NPI:1871850131
Name:GROH, MOIRA GINI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:GINI
Last Name:GROH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3250
Mailing Address - Country:US
Mailing Address - Phone:970-330-4600
Mailing Address - Fax:
Practice Address - Street 1:2003 46TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3250
Practice Address - Country:US
Practice Address - Phone:970-330-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15721223P0221X
NY0578121223P0221X
CO002027381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry