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General NPI Number Information
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NPI Number | 1578766945
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Entity Type | Individual
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Provider Name | CONRAD PETER GROSS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4205 US HIGHWAY 9
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City | HOWELL
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State | NJ
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Zip | 07731-3308
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Country | US
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Telephone | 732-370-8640
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Fax | 732-370-7923
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Provider Business Mailing Address
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Address Line | 26 CANTERBURY WAY
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City | FARMINGDALE
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State | NJ
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Zip | 07727-3871
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Country | US
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Telephone | 732-751-1395
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DI015418
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License Number State | NJ
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