MEDICARE: GROSLEIB DDS CORPORATION, APC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1518317452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROSLEIB DDS CORPORATION, APC

Provider Business Mailing Address
First Line	:	12131 MAGNOLIA BLVD
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-5054
Country	:	US
Telephone Number	:	818-763-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 SUNSET BLVD., SUITE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2168
Country	:	US
Telephone Number	:	213-380-2008
Fax Number	:	213-484-0758

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES WILLIAM GROSLEIB
Credential	:	DDS
Telephone Number	:	818-763-8999

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	05/09/2018

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