Provider Demographics
NPI:1528164613
Name:GROISSER, GORDON S (DDS, MSD)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:S
Last Name:GROISSER
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:555 QUINCE ORCHARD ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-869-4242
Mailing Address - Fax:301-963-8771
Practice Address - Street 1:555 QUINCE ORCHARD ROAD
Practice Address - Street 2:SUITE 230
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878
Practice Address - Country:US
Practice Address - Phone:301-869-4242
Practice Address - Fax:301-963-8771
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD135071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics