Provider Demographics
NPI:1932267630
Name:GRODIN, ALAN R (DDS)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:GRODIN
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 1:430 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-2012
Mailing Address - Country:US
Mailing Address - Phone:248-288-1110
Mailing Address - Fax:248-288-1568
Practice Address - Street 1:430 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-2012
Practice Address - Country:US
Practice Address - Phone:248-288-1110
Practice Address - Fax:248-288-1568
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0133001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice