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General NPI Number Information
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NPI Number | 1902475767
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Entity Type | Individual
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Provider Name | MARGARET ELYSE GROTHE DMD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2021
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 63 E MAIN ST
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City | NEW LONDON
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State | OH
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Zip | 44851-1233
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Country | US
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Telephone | 419-929-1544
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Fax |
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Provider Business Mailing Address
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Address Line | 1 N MAIN ST STE A
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City | ALGONQUIN
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State | IL
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Zip | 60102-2490
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Country | US
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Telephone | 224-333-2063
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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 | 019.034746
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License Number State | IL
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