MEDICARE: DR. PATRICK M GROGAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN4961	DC

General Provider Information

NPI Number	:	1043542590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK M GROGAN DDS

Provider Business Mailing Address
First Line	:	5039 CONNECTICUT AVE NW
Second Line	:	T-2
City	:	WASHINGTON
State	:	DC
Zip	:	20008
Country	:	US
Telephone Number	:	202-363-1314
Fax Number	:

Provider Business Practice Location Address
First Line	:	5039 CONNECTICUT AVE NW
Second Line	:	T-2
City	:	WASHINGTON
State	:	DC
Zip	:	20008
Country	:	US
Telephone Number	:	202-363-1314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	02/09/2010

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