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General NPI Number Information
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NPI Number | 1700936069
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Entity Type | Individual
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Provider Name | DR. REBECCA BURACK GROSS
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1146 N NEW HOPE RD
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City | GASTONIA
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State | NC
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Zip | 28054-2959
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Country | US
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Telephone | 704-865-6425
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Fax | 704-865-2568
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Provider Business Mailing Address
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Address Line | 1146 N NEW HOPE RD
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City | GASTONIA
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State | NC
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Zip | 28054-2959
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Country | US
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Telephone | 704-865-6425
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Fax | 704-865-2568
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | N6197
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License Number State | NC
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