Shawn Reed Groll, DMD
Individual provider Active NPI General Practice Dentistry · Hyrum, UT
NPI 1700801644 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1700801644
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 973464979922 (UT)
- Practice address
- 26 W Main St
Hyrum, UT 84319-1206 - Phone
- (435) 245-5866
- Fax
- (435) 245-5869
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- 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 |
|---|---|---|---|---|
| I20160921000554 | UT | Order and Referring Only - Dentist |
4789971607 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 973464979922 | UT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Family Dental PC | General Practice | Current | Accepting new patients |
Locations
26 W Main St
Hyrum, UT 84319
Phone (435) 245-0550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 973464979922 | UT | Yes |
Addresses
Primary practice location
26 W Main St
Hyrum, UT 84319-1206
Mailing address
26 W Main St
Hyrum, UT 84319-1206
Phone (435) 245-5866
Other providers in Hyrum, UT
- Larissa De Medeiros Vecchi
- Everyday Change Counseling, LLC
- Alissa Jordan Ferrell
- Dylan Cade Freston
- Charles James Graham
- Gunnell Family Dentistry
- Kaiya Haimin
- HC Healthcare, LLC
- McCall Hopkins
- Christina S. Howell
All providers in Hyrum, UT · General Practice Dentistry in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.