MEDICARE: MICHAEL E. GROSSO DDS PC

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
1	122300000X	Dentist	0401410772	VA

General Provider Information

NPI Number	:	1104932946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL E. GROSSO DDS PC

Provider Business Mailing Address
First Line	:	2946 SLEEPY HOLLOW RD
Second Line	:	SUITE #2-G
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2003
Country	:	US
Telephone Number	:	703-532-0072
Fax Number	:	703-532-0213

Provider Business Practice Location Address
First Line	:	2946 SLEEPY HOLLOW RD
Second Line	:	SUITE #2-G
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2003
Country	:	US
Telephone Number	:	703-532-0072
Fax Number	:	703-532-0213

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. MICHAEL EDWARD GROSSO
Credential	:	DDS
Telephone Number	:	703-532-0072

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	08/22/2020

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