Provider Demographics
NPI:1104989359
Name:GROVE, JOHN PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:GROVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:812 ALLEGHENY STREET
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-0508
Mailing Address - Country:US
Mailing Address - Phone:570-398-2270
Mailing Address - Fax:
Practice Address - Street 1:812 ALLEGHENY STREET
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-0508
Practice Address - Country:US
Practice Address - Phone:570-398-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021672L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist