Provider Demographics
NPI:1851412613
Name:GROTHE, JOHN K (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:GROTHE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:BRAD
Other - Middle Name:R
Other - Last Name:GOSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:8454 NORTHCLIFFE BLVD
Mailing Address - Street 2:LAKESIDE FAMILY DENTAL CARE
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606
Mailing Address - Country:US
Mailing Address - Phone:352-686-1122
Mailing Address - Fax:352-688-8693
Practice Address - Street 1:8454 NORTHCLIFFE BLVD
Practice Address - Street 2:LAKESIDE FAMILY DENTAL CARE
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1140
Practice Address - Country:US
Practice Address - Phone:352-686-1122
Practice Address - Fax:352-688-8693
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0144481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice