Provider Demographics
NPI:1205450939
Name:GROVER, AISLINN B
Entity type:Individual
Prefix:
First Name:AISLINN
Middle Name:B
Last Name:GROVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 496
Mailing Address - Street 2:
Mailing Address - City:BLUEWATER
Mailing Address - State:NM
Mailing Address - Zip Code:87005-0496
Mailing Address - Country:US
Mailing Address - Phone:575-915-5369
Mailing Address - Fax:
Practice Address - Street 1:INDIAN SERVICE RTE 140 & INDIAN SERVICE ROUTE 125
Practice Address - Street 2:
Practice Address - City:PINEHILL
Practice Address - State:NM
Practice Address - Zip Code:87357
Practice Address - Country:US
Practice Address - Phone:505-806-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH3598124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist