Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 9440 | NC |
NPI | 1073585915 |
---|---|
Provider Name | Dr. Daniel E Grossman |
First Address | Raleigh, NC 27614-7637 |
Second Address | Raleigh, NC 27613-1371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2006 |
Last Update Date | 11/03/2019 |