Provider Demographics
NPI:1316169733
Name:GROTHOUSE, ERIK GENE (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:GENE
Last Name:GROTHOUSE
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 1:7962 OAKLANDON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:OAKLANDON
Mailing Address - State:IN
Mailing Address - Zip Code:46236-7502
Mailing Address - Country:US
Mailing Address - Phone:317-823-1780
Mailing Address - Fax:
Practice Address - Street 1:7962 OAKLANDON RD STE 105
Practice Address - Street 2:
Practice Address - City:OAKLANDON
Practice Address - State:IN
Practice Address - Zip Code:46236-7502
Practice Address - Country:US
Practice Address - Phone:317-823-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120089081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice