Healthcare Provider Details

I. General information

NPI: 1902475767
Provider Name (Legal Business Name): MARGARET ELYSE GROTHE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 E MAIN ST
NEW LONDON OH
44851-1233
US

IV. Provider business mailing address

1 N MAIN ST STE A
ALGONQUIN IL
60102-2490
US

V. Phone/Fax

Practice location:
  • Phone: 419-929-1544
  • Fax:
Mailing address:
  • Phone: 224-333-2063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.034746
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: