MEDICARE: DR. SARAH PAVON GROY DMD MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401414684	VA

General Provider Information

NPI Number	:	1659829703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH PAVON GROY DMD MS

Provider Business Mailing Address
First Line	:	207 80TH ST UNIT A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-1930
Country	:	US
Telephone Number	:	757-288-0791
Fax Number	:

Provider Business Practice Location Address
First Line	:	996 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3175
Country	:	US
Telephone Number	:	757-496-6030
Fax Number	:

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

Provider Enumeration Date	:	09/19/2016
Last Update Date	:	09/19/2016

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