Provider Demographics
NPI:1528292554
Name:GROVO, HOLLY MARIE (RDH BS)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:GROVO
Suffix:
Gender:F
Credentials:RDH BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3574
Mailing Address - Country:US
Mailing Address - Phone:207-324-0026
Mailing Address - Fax:207-324-0013
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3574
Practice Address - Country:US
Practice Address - Phone:207-324-0026
Practice Address - Fax:207-324-0013
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3197124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist