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General NPI Number Information
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NPI Number | 1821203472
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Entity Type | Organization
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Legal Business Name | STEVEN GROSSMAN DDS PC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 370 KINGS MALL CT
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City | KINGSTON
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State | NY
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Zip | 12401-1576
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Country | US
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Telephone | 845-336-8478
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Fax | 845-336-8607
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Provider Business Mailing Address
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Address Line | 370 KINGS MALL CT
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City | KINGSTON
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State | NY
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Zip | 12401-1576
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Country | US
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Telephone | 845-336-8478
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Fax | 845-336-8607
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MRS. ELAINE CRUZ
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Credential |
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Telephone | 845-336-8478
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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 | 28057
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License Number State | NY
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