Healthcare Provider Details

I. General information

NPI: 1760312417
Provider Name (Legal Business Name): TROY VAN DER GROEN DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 CIVIC DR STE 101
WALNUT CREEK CA
94596-3760
US

IV. Provider business mailing address

537 34TH AVE
SAN FRANCISCO CA
94121-2705
US

V. Phone/Fax

Practice location:
  • Phone: 925-940-2530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: TROY VAN DER GROEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 925-348-3118