Provider Demographics
NPI:1285929638
Name:GROFF, TARA LINDHOLM (DMD, MS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LINDHOLM
Last Name:GROFF
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2386
Mailing Address - Country:US
Mailing Address - Phone:781-312-0444
Mailing Address - Fax:
Practice Address - Street 1:648 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2386
Practice Address - Country:US
Practice Address - Phone:781-312-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855698122300000X, 1223P0221X
MI2901021767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist