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General NPI Number Information
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NPI Number | 1104932946
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Entity Type | Organization
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Legal Business Name | MICHAEL E. GROSSO DDS PC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2946 SLEEPY HOLLOW RD SUITE #2-G
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City | FALLS CHURCH
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State | VA
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Zip | 22044-2003
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Country | US
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Telephone | 703-532-0072
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Fax | 703-532-0213
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Provider Business Mailing Address
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Address Line | 2946 SLEEPY HOLLOW RD SUITE #2-G
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City | FALLS CHURCH
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State | VA
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Zip | 22044-2003
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Country | US
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Telephone | 703-532-0072
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Fax | 703-532-0213
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MICHAEL EDWARD GROSSO
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Credential | DDS
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Telephone | 703-532-0072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410772
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License Number State | VA
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