Provider Demographics
NPI:1952564460
Name:GROCE, TYWANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TYWANA
Middle Name:
Last Name:GROCE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 9699
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29604
Mailing Address - Country:US
Mailing Address - Phone:864-232-8393
Mailing Address - Fax:864-242-6944
Practice Address - Street 1:10 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2142
Practice Address - Country:US
Practice Address - Phone:864-232-8393
Practice Address - Fax:864-242-6944
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4483122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist