Healthcare Provider Details

I. General information

NPI: 1457279994
Provider Name (Legal Business Name): THE GROVE DENTISTRY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WINTER GARDEN VINELAND RD
WINTER GARDEN FL
34787-5483
US

IV. Provider business mailing address

7418 JOHN HANCOCK DR
WINTER GARDEN FL
34787-5690
US

V. Phone/Fax

Practice location:
  • Phone: 407-654-1296
  • Fax:
Mailing address:
  • Phone: 386-453-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PHUONG KIM VAN
Title or Position: OWNER/PRESIDENT
Credential: DMD
Phone: 386-453-8036