MEDICARE: DR. NORMAN EUGENE GROVER DMD

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	12644	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107482	OTHER	MO	BC BS FEDERAL
2	527045	OTHER	MO	UNITED CONCORDIA

General Provider Information

NPI Number	:	1417995952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN EUGENE GROVER DMD

Provider Business Mailing Address
First Line	:	414 W JAMES BLVD
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-1219
Country	:	US
Telephone Number	:	573-265-8402
Fax Number	:	573-265-8802

Provider Business Practice Location Address
First Line	:	414 W JAMES BLVD
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-1219
Country	:	US
Telephone Number	:	573-265-8402
Fax Number	:	573-265-8802

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/09/2007

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