Provider Demographics
NPI:1013067503
Name:GROOMES DENTAL P.A.
Entity type:Organization
Organization Name:GROOMES DENTAL P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROOMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-567-2997
Mailing Address - Street 1:37149 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-4625
Mailing Address - Country:US
Mailing Address - Phone:352-567-2997
Mailing Address - Fax:352-567-3284
Practice Address - Street 1:37149 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4625
Practice Address - Country:US
Practice Address - Phone:352-567-2997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL159781223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty