Provider Demographics
NPI:1720460777
Name:GROSS, DANIEL ARIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ARIEL
Last Name:GROSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:26789 WOODWARD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1334
Mailing Address - Country:US
Mailing Address - Phone:248-607-3256
Mailing Address - Fax:
Practice Address - Street 1:26789 WOODWARD AVE STE 202
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1334
Practice Address - Country:US
Practice Address - Phone:248-607-3256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010216221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics