Provider Demographics
NPI:1932323433
Name:MARC L GROSSMAN DDS JAMES B SMITH DDS APC
Entity Type:Organization
Organization Name:MARC L GROSSMAN DDS JAMES B SMITH DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-722-9202
Mailing Address - Street 1:228 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3136
Mailing Address - Country:US
Mailing Address - Phone:831-722-9202
Mailing Address - Fax:831-722-4301
Practice Address - Street 1:228 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3136
Practice Address - Country:US
Practice Address - Phone:831-722-9202
Practice Address - Fax:831-722-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty