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General NPI Number Information
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NPI Number | 1043681836
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Entity Type | Organization
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Legal Business Name | GROSMAN PEDIATRIC DENTISTRY AND ORTHODONTICS
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 4401 S FLAMINGO RD STE 109
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City | DAVIE
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State | FL
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Zip | 33330-1914
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Country | US
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Telephone | 954-236-3434
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Fax | 954-236-3405
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Provider Business Mailing Address
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Address Line | 4401 S FLAMINGO RD STE 109
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City | DAVIE
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State | FL
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Zip | 33330-1914
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Country | US
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Telephone | 954-236-3434
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Fax | 954-236-3405
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Authorized Official
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Title or Position | OWNER
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Name | MARIA MARRANZINI-GROSMAN
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Credential |
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Telephone | 954-236-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN20826
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D15664
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN 15203
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License Number State | FL
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