Provider Demographics
NPI:1285768630
Name:GROSSO-WOOLDRIDGE, MARIA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:GROSSO-WOOLDRIDGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 S DALE MABRY HWY STE C
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6322
Mailing Address - Country:US
Mailing Address - Phone:305-868-8500
Mailing Address - Fax:
Practice Address - Street 1:1010 71 ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141
Practice Address - Country:US
Practice Address - Phone:305-868-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist