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General NPI Number Information
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NPI Number | 1578964060
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Entity Type | Organization
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Legal Business Name | GROSSMAN DDS, INCORPORATED
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 27569 HOPI SPRINGS CT
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City | CORONA
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State | CA
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Zip | 92883-6606
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Country | US
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Telephone | 951-674-2720
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Fax | 951-346-3253
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Provider Business Mailing Address
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Address Line | 27569 HOPI SPRINGS CT
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City | CORONA
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State | CA
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Zip | 92883-6606
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Country | US
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Telephone | 951-674-2720
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Fax | 951-346-3253
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN ROBERT GROSSMAN
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Credential | DDS
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Telephone | 951-674-2720
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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 | 41413
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License Number State | CA
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