Provider Demographics
NPI:1285347138
Name:JOSHUA GROPPER DMD LLC
Entity type:Organization
Organization Name:JOSHUA GROPPER DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:GROPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-853-0682
Mailing Address - Street 1:712 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4827
Mailing Address - Country:US
Mailing Address - Phone:770-229-2811
Mailing Address - Fax:
Practice Address - Street 1:712 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4827
Practice Address - Country:US
Practice Address - Phone:770-229-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental