Richard J. Gromofsky Jr., D.D.S.
Individual provider Active NPI Dentist · Richfield, OH
NPI 1811029481 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1811029481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 19675 (OH)
- Practice address
- 4336 Brecksville Rd
Suite C
Richfield, OH 44286-9457 - Phone
- (330) 659-9363
- NPI assigned
- Mar 9, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- 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 |
|---|---|---|---|---|
| I20150408001438 | OH | Order and Referring Only - Oral Surgery |
7719205582 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19675 | OH | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 19675 | OH | Yes |
Addresses
Primary practice location
4336 Brecksville Rd
Suite C
Richfield, OH 44286-9457
Mailing address
4336 Brecksville Rd
Suite C
Richfield, OH 44286-9457
Phone (330) 659-9363
Other providers in Richfield, OH
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.