Provider Demographics
NPI:1700095254
Name:GROEN, DEANNA P (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:P
Last Name:GROEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-1012
Mailing Address - Country:US
Mailing Address - Phone:617-959-6577
Mailing Address - Fax:
Practice Address - Street 1:154 HARDING ST
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-1012
Practice Address - Country:US
Practice Address - Phone:617-959-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN212541223G0001X
IL019.0269541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice