Healthcare Provider Details

I. General information

NPI: 1992706535
Provider Name (Legal Business Name): RONALD WAYNE GROUT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/08/2007
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 TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3753
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: