Greendale Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

16451 Issued in MA

Legal business name

GREENDALE DENTAL

Practice address

500 W Boylston St
Worcester, MA 01606-2058

Phone

(508) 852-6616

Fax

(508) 854-1037

NPI assigned

Apr 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kerry Mark Grolman, D.D.S.

Title

Owner

Phone

(508) 852-6616

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328572800000",
    "number": "1730305228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W BOYLSTON ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062058",
            "telephone_number": "508-852-6616",
            "fax_number": "508-854-1037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BOYLSTON ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062058",
            "telephone_number": "508-852-6616",
            "fax_number": "508-854-1037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENDALE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2012-02-07",
        "status": "A",
        "authorized_official_last_name": "GROLMAN",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-852-6616",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "16451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian J. Greenberg, CNP
• Bruce August Greenberg, MD
• Jeffrey J Greenberg, MD
• Joshua M Greenberg, M.D.
• Rachel Laurie Greenberg
• Deovioynne Greene
• Elizabeth Ann Greene, LMHC MFT
• Robert Joseph Greene, DPM
• Ronald T. Greene, D.O.
• Cynthia E. Greenhouse

• General Practice Dentistry in Worcester, MA
• Providers in Worcester, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.