Healthcare Provider Details

I. General information

NPI: 1770050544
Provider Name (Legal Business Name): WILLIAM B GROSS DDS OF GREENSBORO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 05/25/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2733 HORSE PEN CREEK RD STE 107
GREENSBORO NC
27410-8538
US

IV. Provider business mailing address

2733 HORSE PEN CREEK ROAD 107
GREENBORO NC
27513-9742
US

V. Phone/Fax

Practice location:
  • Phone: 336-854-9270
  • Fax:
Mailing address:
  • Phone: 201-404-1798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM BERNARD GROSS
Title or Position: DENTIST
Credential: DDS
Phone: 201-404-1798