Provider Demographics
NPI:1659443117
Name:GROSS, TIMOTHY P (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:GROSS
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 1:25 HOSPITAL CENTER BLVD
Mailing Address - Street 2:MEDICAL PAVILION STE.102
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2738
Mailing Address - Country:US
Mailing Address - Phone:843-342-7700
Mailing Address - Fax:843-342-7703
Practice Address - Street 1:25 HOSPITAL CENTER BLVD
Practice Address - Street 2:MEDICAL PAVILION STE. 102
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2738
Practice Address - Country:US
Practice Address - Phone:843-342-7700
Practice Address - Fax:843-342-7703
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-028129-L1223G0001X
SCDGD45521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice