MEDICARE: MICHAEL GROSS DMD, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DE61213596	WA

General Provider Information

NPI Number	:	1154821924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GROSS DMD, MD

Provider Business Mailing Address
First Line	:	16410 SMOKEY POINT BLVD STE 103
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-8415
Country	:	US
Telephone Number	:	360-658-8822
Fax Number	:

Provider Business Practice Location Address
First Line	:	16410 SMOKEY POINT BLVD STE 103
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-8415
Country	:	US
Telephone Number	:	360-658-8822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2018
Last Update Date	:	02/09/2026

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