MEDICARE: DR. RONALD WAYNE GROUT 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
1	1223G0001X	General Practice Dentistry	3753	CO
2	1223G0001X	General Practice Dentistry	35893	CA

General Provider Information

NPI Number	:	1992706535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD WAYNE GROUT DDS

Provider Business Mailing Address
First Line	:	8 W DRY CREEK CIR
Second Line	:	STE 101
City	:	LITTLETON
State	:	CO
Zip	:	80120-4477
Country	:	US
Telephone Number	:	303-730-1222
Fax Number	:	303-730-2096

Provider Business Practice Location Address
First Line	:	8 W DRY CREEK CIR
Second Line	:	STE 101
City	:	LITTLETON
State	:	CO
Zip	:	80120-4477
Country	:	US
Telephone Number	:	303-730-1222
Fax Number	:	303-730-2096

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

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	07/08/2007

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