Provider Demographics
NPI:1952714008
Name:GROSS, KELSEY HEATHER (DDS)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:HEATHER
Last Name:GROSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 WORLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-5698
Mailing Address - Country:US
Mailing Address - Phone:440-539-4505
Mailing Address - Fax:
Practice Address - Street 1:34501 AURORA RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3873
Practice Address - Country:US
Practice Address - Phone:440-248-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-024180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist