Healthcare Provider Details

I. General information

NPI: 1114577061
Provider Name (Legal Business Name): AARON M GROSS DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 WHITNEY AVE
HAMDEN CT
06517-2813
US

IV. Provider business mailing address

1240 WHITNEY AVE
HAMDEN CT
06517-2813
US

V. Phone/Fax

Practice location:
  • Phone: 203-287-0666
  • Fax:
Mailing address:
  • Phone: 203-287-0666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: AARON GROSS
Title or Position: OWNER
Credential: DMD
Phone: 203-287-0666