MEDICARE: KEVIN D. GROSS 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS7297	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720085483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN D. GROSS DDS

Provider Business Mailing Address
First Line	:	603 HIGHWAY 321 N UNIT 20 BLDG 4
Second Line	:	LENOIR CITY PROF. PARK
City	:	LENOIR CITY
State	:	TN
Zip	:	37771-6575
Country	:	US
Telephone Number	:	865-986-4582
Fax Number	:	865-988-8398

Provider Business Practice Location Address
First Line	:	603 HIGHWAY 321 N UNIT 20 BLDG 4
Second Line	:	LENOIR CITY PROF. PARK
City	:	LENOIR CITY
State	:	TN
Zip	:	37771-6575
Country	:	US
Telephone Number	:	865-986-4582
Fax Number	:	865-988-8398

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/24/2021

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