Healthcare Provider Details

I. General information

NPI: 1356328306
Provider Name (Legal Business Name): PETER MICHAEL GRONET DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-5352
  • Fax:
Mailing address:
  • Phone: 502-287-5352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number12009306A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number6505
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: