Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 11818 | FL |
NPI | 1629148770 |
---|---|
Provider Name | Dr. David L. Grochmal |
First Address | Middleburg, FL 32068-6651 |
Second Address | Jacksonville, FL 32256-9179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |