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General NPI Number Information
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NPI Number | 1861881260
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Entity Type | Organization
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Legal Business Name | DANIEL GROSSMAN, DDS, PA
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 8200 CREEDMOOR RD
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City | RALEIGH
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State | NC
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Zip | 27613-1371
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Country | US
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Telephone | 919-847-6364
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Fax |
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Provider Business Mailing Address
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Address Line | 1444 TACKETTS POND DR
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City | RALEIGH
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State | NC
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Zip | 27614-7637
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL E GROSSMAN
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Credential | DDS
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Telephone | 919-919-8476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9440
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License Number State | NC
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