Healthcare Provider Details

I. General information

NPI: 1245061571
Provider Name (Legal Business Name): JULIE GROBOIS DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N DIVISION ST
PEEKSKILL NY
10566-2944
US

IV. Provider business mailing address

435 CENTRAL PARK W APT 1T
NEW YORK NY
10025-4340
US

V. Phone/Fax

Practice location:
  • Phone: 914-630-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number064077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: