Provider Demographics
NPI:1336149368
Name:GROUT, JEFFREY BLAKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BLAKE
Last Name:GROUT
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 1:8 W DRY CREEK CIR
Mailing Address - Street 2:#101
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4477
Mailing Address - Country:US
Mailing Address - Phone:303-730-1222
Mailing Address - Fax:303-730-2096
Practice Address - Street 1:8 W DRY CREEK CIR
Practice Address - Street 2:#101
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4477
Practice Address - Country:US
Practice Address - Phone:303-730-1222
Practice Address - Fax:303-730-2096
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436031223G0001X
CO74741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice