Provider Demographics
NPI:1922362508
Name:GROTE, NICHOLAS PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:PAUL
Last Name:GROTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:PAUL
Other - Last Name:GROTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:8309 PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6141
Mailing Address - Country:US
Mailing Address - Phone:479-484-7645
Mailing Address - Fax:
Practice Address - Street 1:8309 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6141
Practice Address - Country:US
Practice Address - Phone:479-484-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice