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General NPI Number Information
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NPI Number | 1619078540
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Entity Type | Individual
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Provider Name | MICHAEL EDWARD DEGROOD D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 190 N CHARLES RICHARD BEALL BLVD STE 104
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City | DEBARY
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State | FL
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Zip | 32713-2218
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Country | US
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Telephone | 386-668-0999
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Fax |
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Provider Business Mailing Address
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Address Line | 190 N CHARLES RICHARD BEALL BLVD STE 104
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City | DEBARY
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State | FL
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Zip | 32713
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Country | US
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Telephone | 386-668-0999
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 0012305
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License Number State | FL
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