MEDICARE: DR. ANTHONY IRVING GRONICH 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	11084	TX

General Provider Information

NPI Number	:	1477556058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY IRVING GRONICH DDS

Provider Business Mailing Address
First Line	:	4664 GLOBE WILLOW DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79922-2200
Country	:	US
Telephone Number	:	915-584-7576
Fax Number	:	915-584-7576

Provider Business Practice Location Address
First Line	:	5665 TRANSMOUNTAIN DR
Second Line	:	STE 201
City	:	EL PASO
State	:	TX
Zip	:	79924-4100
Country	:	US
Telephone Number	:	915-751-7779
Fax Number	:	915-755-2265

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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