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General NPI Number Information
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NPI Number | 1689852477
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Entity Type | Organization
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Legal Business Name | M TODD GROOMS DDS PA
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 306 ALAMANCE RD STE C
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City | BURLINGTON
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State | NC
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Zip | 27215-5684
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Country | US
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Telephone | 336-227-5444
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Fax | 336-227-0029
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Provider Business Mailing Address
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Address Line | 306 ALAMANCE RD STE C
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City | BURLINGTON
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State | NC
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Zip | 27215-5684
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Country | US
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Telephone | 336-227-5444
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Fax | 336-227-0029
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Authorized Official
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Title or Position | FINANCIAL MANAGER
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Name | DENISE B. HAMMOND
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Credential |
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Telephone | 336-227-5444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7197
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License Number State | NC
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