Healthcare Provider Details

I. General information

NPI: 1932352887
Provider Name (Legal Business Name): EUGENE J GROSS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 464 BOX# 3055
APO AE
09226
US

IV. Provider business mailing address

CMR 464 BOX# 3055
APO AE
09226
US

V. Phone/Fax

Practice location:
  • Phone: 314-476-4738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS037576
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: