Healthcare Provider Details

I. General information

NPI: 1851453997
Provider Name (Legal Business Name): ROBERT LEWIS GROESBECK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13869 W BELL RD STE 103
SURPRISE AZ
85374-2468
US

IV. Provider business mailing address

13869 W BELL RD STE 103
SURPRISE AZ
85374-2468
US

V. Phone/Fax

Practice location:
  • Phone: 623-584-4015
  • Fax:
Mailing address:
  • Phone: 623-584-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number44405
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7518
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number26206
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: