Provider Demographics
NPI:1104932946
Name:MICHAEL E. GROSSO DDS PC
Entity type:Organization
Organization Name:MICHAEL E. GROSSO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-532-0072
Mailing Address - Street 1:2946 SLEEPY HOLLOW RD
Mailing Address - Street 2:SUITE #2-G
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2003
Mailing Address - Country:US
Mailing Address - Phone:703-532-0072
Mailing Address - Fax:703-532-0213
Practice Address - Street 1:2946 SLEEPY HOLLOW RD
Practice Address - Street 2:SUITE #2-G
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2003
Practice Address - Country:US
Practice Address - Phone:703-532-0072
Practice Address - Fax:703-532-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty