Provider Demographics
NPI:1316422066
Name:GROTH DENTAL, PLLC
Entity type:Organization
Organization Name:GROTH DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-885-8247
Mailing Address - Street 1:32100 TELEGRAPH RD STE 195
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2453
Mailing Address - Country:US
Mailing Address - Phone:248-885-8247
Mailing Address - Fax:
Practice Address - Street 1:32100 TELEGRAPH RD STE 195
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2453
Practice Address - Country:US
Practice Address - Phone:248-885-8247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty