MEDICARE: DANIEL GROSSMAN DMD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	7732	KY

General Provider Information

NPI Number	:	1831258185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL GROSSMAN DMD

Provider Business Mailing Address
First Line	:	4229 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3241
Country	:	US
Telephone Number	:	502-491-6480
Fax Number	:	502-491-1987

Provider Business Practice Location Address
First Line	:	4229 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3241
Country	:	US
Telephone Number	:	502-491-6480
Fax Number	:	502-491-1987

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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