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General NPI Number Information
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NPI Number | 1477686962
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Entity Type | Individual
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Provider Name | LESLIE RAYMOND GROSS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 722 MARKET ST
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City | PHILADELPHIA
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State | PA
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Zip | 19106-2312
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Country | US
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Telephone | 215-922-5101
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Fax |
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Provider Business Mailing Address
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Address Line | 777 W GERMANTOWN PIKE APT 923
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1022
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Country | US
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Telephone | 610-279-7292
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DS035483
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License Number State | PA
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