Healthcare Provider Details

I. General information

NPI: 1760465355
Provider Name (Legal Business Name): THOMAS BAYARD GROSH III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 MOUNT PLEASANT RD
COLUMBIA PA
17512-8724
US

IV. Provider business mailing address

1430 MOUNT PLEASANT RD
COLUMBIA PA
17512-8724
US

V. Phone/Fax

Practice location:
  • Phone: 717-426-1867
  • Fax:
Mailing address:
  • Phone: 717-426-1867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS018368
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: