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NPI Code Detail

MEDICARE: RALPH ERNEST GROSSHEIM JR. DDS

MEDICARE: RALPH ERNEST GROSSHEIM JR. 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
1122300000XDentistD57680TN

General Provider Information

NPI Number : 1851372056
Entity Type Code : Individual
Provider Name (Legal Business Name) : RALPH ERNEST GROSSHEIM JR. DDS
Provider Business Mailing Address
First Line : 1001 OLD HIGHWAY 99
Second Line :
City : COLUMBIA
State : TN
Zip : 38401-7720
Country : US
Telephone Number : 931-381-7667
Fax Number :
Provider Business Practice Location Address
First Line : 51 SMITH AVE
Second Line :
City : HOHENWALD
State : TN
Zip : 38462-1124
Country : US
Telephone Number : 931-796-2204
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 07/08/2007

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