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NPI Code Detail

MEDICARE: DR. HANNAH ELIZABETH GROH DDS

MEDICARE: DR. HANNAH ELIZABETH GROH DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry38674TX
2122300000XDentist019.032656IL

General Provider Information

NPI Number : 1063030856
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HANNAH ELIZABETH GROH DDS
Provider Business Mailing Address
First Line : 3600 S LAMAR BLVD APT 213
Second Line :
City : AUSTIN
State : TX
Zip : 78704-8098
Country : US
Telephone Number : 317-213-7439
Fax Number :
Provider Business Practice Location Address
First Line : 6104 S 1ST ST STE 103
Second Line :
City : AUSTIN
State : TX
Zip : 78745-4052
Country : US
Telephone Number : 512-222-9772
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2020
Last Update Date : 08/15/2022

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