MEDICARE: DR. ADAM MICHAEL GROMAK 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
1	1223G0001X	General Practice Dentistry	11916	OR
2	122300000X	Dentist	DN19191	FL

General Provider Information

NPI Number	:	1306153150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM MICHAEL GROMAK DDS

Provider Business Mailing Address
First Line	:	PO BOX 366156
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34136-6156
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 366156
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34136-6156
Country	:	US
Telephone Number	:	813-374-0302
Fax Number	:

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

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	09/24/2025

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