Provider Demographics
NPI:1952323230
Name:GROAT, GEOFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:
Last Name:GROAT
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 1:1350 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3532
Mailing Address - Country:US
Mailing Address - Phone:310-832-5133
Mailing Address - Fax:310-832-1150
Practice Address - Street 1:1350 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3532
Practice Address - Country:US
Practice Address - Phone:310-832-5133
Practice Address - Fax:310-832-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry