Provider Demographics
NPI:1912268012
Name:BOBBY J GROSSI DDS OF SWARTZ CREEK
Entity Type:Organization
Organization Name:BOBBY J GROSSI DDS OF SWARTZ CREEK
Other - Org Name:GATEWAY DENTAL SWARTZ CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-820-1537
Mailing Address - Street 1:4495 MORRISH RD
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1346
Mailing Address - Country:US
Mailing Address - Phone:810-635-3511
Mailing Address - Fax:810-635-4439
Practice Address - Street 1:4495 MORRISH RD
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1346
Practice Address - Country:US
Practice Address - Phone:810-635-3511
Practice Address - Fax:810-635-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty