Healthcare Provider Details

I. General information

NPI: 1699008789
Provider Name (Legal Business Name): REENA N GROVER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 DUBLIN BLVD STE E
DUBLIN CA
94568
US

IV. Provider business mailing address

371 VERANO DR
LOS ALTOS CA
94022-2345
US

V. Phone/Fax

Practice location:
  • Phone: 688-092-5803
  • Fax:
Mailing address:
  • Phone: 510-378-3782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58620
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number58620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: