Provider Demographics
NPI:1336277789
Name:GRONICH, NEAL FRANK (DDS)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:FRANK
Last Name:GRONICH
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 1:7598 N MESA ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3517
Mailing Address - Country:US
Mailing Address - Phone:915-581-1300
Mailing Address - Fax:915-581-0824
Practice Address - Street 1:7598 N MESA ST
Practice Address - Street 2:SUITE 208
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3517
Practice Address - Country:US
Practice Address - Phone:915-581-1300
Practice Address - Fax:915-581-0824
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice