Healthcare Provider Details

I. General information

NPI: 1891819983
Provider Name (Legal Business Name): THOMAS D GROOM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1012
US

IV. Provider business mailing address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1012
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-1547
  • Fax: 734-763-5503
Mailing address:
  • Phone: 734-936-1547
  • Fax: 734-763-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901019367
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901019367
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: