Provider Demographics
NPI:1316528243
Name:GROGAN, STEPHANIE GAIL (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:GAIL
Last Name:GROGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:GROGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 GERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3139
Mailing Address - Country:US
Mailing Address - Phone:316-644-7667
Mailing Address - Fax:
Practice Address - Street 1:100 E NEWTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3552
Practice Address - Country:US
Practice Address - Phone:617-414-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program