Provider Demographics
NPI:1205474731
Name:GROSSO ORTHODONTICS, LLC
Entity type:Organization
Organization Name:GROSSO ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-970-3202
Mailing Address - Street 1:9919 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9919 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8530
Practice Address - Country:US
Practice Address - Phone:843-970-3202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROSSO ORTHODONTICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty