MEDICARE: MR. THOMAS BAYARD GROSH III D.D.S.

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	DS018368	PA

General Provider Information

NPI Number	:	1760465355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS BAYARD GROSH III D.D.S.

Provider Business Mailing Address
First Line	:	1430 MOUNT PLEASANT RD
Second Line	:
City	:	COLUMBIA
State	:	PA
Zip	:	17512-8724
Country	:	US
Telephone Number	:	717-426-1867
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 MOUNT PLEASANT RD
Second Line	:
City	:	COLUMBIA
State	:	PA
Zip	:	17512-8724
Country	:	US
Telephone Number	:	717-426-1867
Fax Number	:

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	09/11/2013

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