Healthcare Provider Details

I. General information

NPI: 1497886543
Provider Name (Legal Business Name): MARGUERITE GROSSMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 43RD ST STE 1
BROOKLYN NY
11219-1611
US

IV. Provider business mailing address

1441 43RD ST
BROOKLYN NY
11219-1611
US

V. Phone/Fax

Practice location:
  • Phone: 718-787-5656
  • Fax:
Mailing address:
  • Phone: 718-787-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number047727
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: