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General NPI Number Information
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NPI Number | 1598753972
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Entity Type | Individual
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Provider Name | LOREN JAMES GROSSMAN DMD
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Gender | Male
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 375 PIERCE ST
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City | KINGSTON
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State | PA
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Zip | 18704-5528
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Country | US
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Telephone | 570-283-1130
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Fax | 570-283-3155
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Provider Business Mailing Address
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Address Line | 375 PIERCE ST
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City | KINGSTON
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State | PA
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Zip | 18704-5528
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Country | US
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Telephone | 570-283-1130
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Fax | 570-283-3155
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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 | DS023430L
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License Number State | PA
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