Healthcare Provider Details

I. General information

NPI: 1649334665
Provider Name (Legal Business Name): N.E. GROVER,D.M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W JAMES BLVD
SAINT JAMES MO
65559-1219
US

IV. Provider business mailing address

414 W JAMES BLVD
SAINT JAMES MO
65559-1219
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-8402
  • Fax: 573-265-8802
Mailing address:
  • Phone: 573-265-8402
  • Fax: 573-265-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12644
License Number StateMO

VIII. Authorized Official

Name: MRS. DEANNA KAY GROVER
Title or Position: OFFICE MANAGER
Credential:
Phone: 573-265-8402