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General NPI Number Information
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NPI Number | 1598420465
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE GROSS DMD
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Gender | Female
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 02/16/2025
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Provider Practice Location Address
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Address Line | 22516 SE 64TH PL STE 110
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City | ISSAQUAH
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State | WA
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Zip | 98027-5379
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Country | US
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Telephone | 425-392-9224
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Fax |
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Provider Business Mailing Address
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Address Line | 22516 SE 64TH PL STE 110
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City | ISSAQUAH
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State | WA
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Zip | 98027-5379
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Country | US
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Telephone | 425-392-9224
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE61617755
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License Number State | WA
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