1124134408 NPI number — RONALD M GROSSMAN DDS PA

Table of content: MRS. JULIA HENSLEY LEADFORD S.L.P. (NPI 1114132354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124134408 NPI number — RONALD M GROSSMAN DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD M GROSSMAN DDS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124134408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6525 BELCREST ROAD
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
HYATTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-927-2900
Provider Business Mailing Address Fax Number:
301-927-2747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6525 BELCREST ROAD
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
HYATTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-927-2900
Provider Business Practice Location Address Fax Number:
301-927-2747
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GROSSMAN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
301-927-2900

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6978 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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