Marc L Grossman, D.D.S.
Individual provider Active NPI Pediatric Dentistry · Freedom, CA
NPI 1831237114 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1831237114
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- 26311 (CA)
- Practice address
- 228 Green Valley Rd
Freedom, CA 95019-3136 - Phone
- (831) 722-9202
- Fax
- (831) 722-4301
- NPI assigned
- Feb 1, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26311 | CA | MD | Pediatric Dentist |
Interoperability endpoints
- mgrossman249453@direct-ucsfmedicalcenter.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 26311 | CA | Yes |
Addresses
Primary practice location
228 Green Valley Rd
Freedom, CA 95019-3136
Mailing address
228 Green Valley Rd
Freedom, CA 95019-3136
Phone (831) 722-9202
Other providers in Freedom, CA
- Gordon Gardner Goldstine
- Alexander Leonard Gordon
- Maria Sembrano Granthom
- Green Valley Laser, LLC
- Gilbert J Grio
- Vinh Quoc Ha
- Conrad Hamako
- Lisa Patrice Hamil
- Terry F. Haskin
- Healthstat on-Site Clinic/Reiter Watsonville
All providers in Freedom, CA · Pediatric 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 Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.