Healthcare Provider Details

I. General information

NPI: 1053377242
Provider Name (Legal Business Name): JEFFREY B. GROUT, DDS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 W DRY CREEK CIR STE 101
LITTLETON CO
80120-4477
US

IV. Provider business mailing address

8 W DRY CREEK CIR STE 101
LITTLETON CO
80120-4477
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-1222
  • Fax: 303-730-2096
Mailing address:
  • Phone: 303-730-1222
  • Fax: 303-730-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3753
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY GROUT
Title or Position: PRESIDENT
Credential: DDS
Phone: 303-918-7752