MEDICARE: BOBBY J GROSSI DDS OF SWARTZ CREEK

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	122300000X	Dentist	2901018775	MI

General Provider Information

NPI Number	:	1912268012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOBBY J GROSSI DDS OF SWARTZ CREEK

Provider Business Mailing Address
First Line	:	4495 MORRISH RD
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1346
Country	:	US
Telephone Number	:	810-635-3511
Fax Number	:	810-635-4439

Provider Business Practice Location Address
First Line	:	4495 MORRISH RD
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1346
Country	:	US
Telephone Number	:	810-635-3511
Fax Number	:	810-635-4439

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BOBBY JOHN GROSSI
Credential	:	DDS
Telephone Number	:	810-820-1537

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/05/2012

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