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General NPI Number Information
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NPI Number | 1124134408
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Entity Type | Organization
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Legal Business Name | RONALD M GROSSMAN DDS PA
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 6525 BELCREST ROAD SUITE 212
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City | HYATTSVILLE
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State | MD
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Zip | 20782
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Country | US
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Telephone | 301-927-2900
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Fax | 301-927-2747
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Provider Business Mailing Address
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Address Line | 6525 BELCREST ROAD SUITE 212
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City | HYATTSVILLE
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State | MD
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Zip | 20782
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Country | US
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Telephone | 301-927-2900
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Fax | 301-927-2747
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RONALD MARK GROSSMAN
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Credential | DDS
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Telephone | 301-927-2900
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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 | 6978
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License Number State | MD
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