Provider Demographics
NPI:1184772881
Name:GROVE, JEFFREY N (DMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:N
Last Name:GROVE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 STATE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1904
Mailing Address - Country:US
Mailing Address - Phone:610-372-8406
Mailing Address - Fax:610-372-3998
Practice Address - Street 1:2228 STATE HILL RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1904
Practice Address - Country:US
Practice Address - Phone:610-372-8406
Practice Address - Fax:610-372-3998
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0361141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1640241OtherUNITED CONCORDIA PROVIDER