Provider Demographics
NPI:1699879783
Name:DR. SCOTT A GRASSO DDS PC
Entity type:Organization
Organization Name:DR. SCOTT A GRASSO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-287-8040
Mailing Address - Street 1:3212 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4314
Mailing Address - Country:US
Mailing Address - Phone:765-287-8040
Mailing Address - Fax:765-282-9332
Practice Address - Street 1:3212 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4314
Practice Address - Country:US
Practice Address - Phone:765-287-8040
Practice Address - Fax:765-282-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty