MEDICARE: JEFFREY N. GROVE D.M.D.

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	1223G0001X	General Practice Dentistry	DS036114	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1640241	OTHER	PA	UNITED CONCORDIA PROVIDER

General Provider Information

NPI Number	:	1184772881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY N. GROVE D.M.D.

Provider Business Mailing Address
First Line	:	2228 STATE HILL RD
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-1904
Country	:	US
Telephone Number	:	610-372-8406
Fax Number	:	610-372-3998

Provider Business Practice Location Address
First Line	:	2228 STATE HILL RD
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-1904
Country	:	US
Telephone Number	:	610-372-8406
Fax Number	:	610-372-3998

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	05/24/2016

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