Elizabeth Grover, DDS
Individual provider Active NPI General Practice Dentistry · Winters, CA
NPI 1003478587 · NPPES record last updated Nov 23, 2022
Key facts
- NPI
- 1003478587
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DDS105306 (CA)
- Practice address
- 172 E Grant Ave
Winters, CA 95694-1780 - Phone
- (530) 795-4377
- NPI assigned
- Jul 3, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221207002727 | CA | Order and Referring Only - Dentist |
8628447083 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS105306 | CA | MD | General Practice Dentistry |
Interoperability endpoints
- egrover679823@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DDS105306 | CA | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
172 E Grant Ave
Winters, CA 95694-1780
Mailing address
172 E Grant Ave
Winters, CA 95694-1780
Phone (530) 795-4377
Other providers in Winters, CA
- Amy Erez
- Ofer E Erez
- Ashley Evans
- Gene Alan Gowdey
- Irena Marie Grauzinis
- Carly Grovhoug
- Erin Halk
- Annemarie Paddock Hargadon
- Marcella Heredia
- Dennis Wayne Hiramatsu
All providers in Winters, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.