Provider Demographics
NPI:1700877941
Name:GROSS, JOHNNIE DUNBAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHNNIE
Middle Name:DUNBAR
Last Name:GROSS
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 1:117 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONSON
Mailing Address - State:MA
Mailing Address - Zip Code:01057-1320
Mailing Address - Country:US
Mailing Address - Phone:413-267-5432
Mailing Address - Fax:413-267-5078
Practice Address - Street 1:117 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONSON
Practice Address - State:MA
Practice Address - Zip Code:01057-1320
Practice Address - Country:US
Practice Address - Phone:413-267-5432
Practice Address - Fax:413-267-5078
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA166461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice