Healthcare Provider Details

I. General information

NPI: 1528687514
Provider Name (Legal Business Name): DANIEL LEE GROSBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13034 OLD COLUMBIA PIKE
SILVER SPRING MD
20904-5226
US

IV. Provider business mailing address

13034 OLD COLUMBIA PIKE
SILVER SPRING MD
20904-5226
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-8788
  • Fax:
Mailing address:
  • Phone: 301-384-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15365
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: