Provider Demographics
NPI:1205997939
Name:GROTH, DAVID PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:GROTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32100 TELEGRAPH RD
Mailing Address - Street 2:SUITE 195
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2452
Mailing Address - Country:US
Mailing Address - Phone:248-644-6433
Mailing Address - Fax:
Practice Address - Street 1:32100 TELEGRAPH RD
Practice Address - Street 2:SUITE 195
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2452
Practice Address - Country:US
Practice Address - Phone:248-644-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010121891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice