Healthcare Provider Details

I. General information

NPI: 1831280098
Provider Name (Legal Business Name): ROBERT A GROLLMAN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NORTH MAIN ST
ALPHARETTA GA
30004-1623
US

IV. Provider business mailing address

160 NORTH MAIN ST
ALPHARETTA GA
30004-1623
US

V. Phone/Fax

Practice location:
  • Phone: 770-475-3432
  • Fax: 770-475-4019
Mailing address:
  • Phone: 770-475-3432
  • Fax: 770-475-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN007173
License Number StateGA

VIII. Authorized Official

Name: DR. ROBERT ALLAN GROLLMAN
Title or Position: PRES OWNER
Credential: DDS
Phone: 770-475-3432