Provider Demographics
NPI:1922261601
Name:GROVE, RAYMOND LLOYD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LLOYD
Last Name:GROVE
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 1:8601 WEST DODGE RD
Mailing Address - Street 2:#148
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-343-0202
Mailing Address - Fax:402-343-0817
Practice Address - Street 1:8601 WEST DODGE RD
Practice Address - Street 2:#148
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-343-0202
Practice Address - Fax:402-343-0817
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice