Healthcare Provider Details

I. General information

NPI: 1881708402
Provider Name (Legal Business Name): STEVEN P GROSSMAN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9433 OLIVE BLVD STE 200
SAINT LOUIS MO
63132-3132
US

IV. Provider business mailing address

9433 OLIVE BLVD STE 200
SAINT LOUIS MO
63132-3132
US

V. Phone/Fax

Practice location:
  • Phone: 314-993-6706
  • Fax: 314-993-1263
Mailing address:
  • Phone: 314-993-6706
  • Fax: 314-993-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberPO0406945
License Number StateMO

VIII. Authorized Official

Name: DR. STEVEN P GROSSMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 314-993-6706