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General NPI Number Information
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NPI Number | 1700095254
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Entity Type | Individual
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Provider Name | DEANNA P. GROEN DDS
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 154 HARDING ST
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City | MEDFIELD
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State | MA
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Zip | 02052-1012
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Country | US
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Telephone | 617-959-6577
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Fax |
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Provider Business Mailing Address
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Address Line | 154 HARDING ST
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City | MEDFIELD
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State | MA
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Zip | 02052-1012
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Country | US
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Telephone | 617-959-6577
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN21254
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.026954
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License Number State | IL
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