Healthcare Provider Details

I. General information

NPI: 1306153150
Provider Name (Legal Business Name): ADAM MICHAEL GROMAK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 366156
BONITA SPRINGS FL
34136-6156
US

IV. Provider business mailing address

PO BOX 366156
BONITA SPRINGS FL
34136-6156
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-0302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN19191
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11916
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: