Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 9498 | TX |
NPI | 1003929548 |
---|---|
Provider Name | Dr. Donald D Groba |
First Address | Porter, TX 77365 |
Second Address | New Caney, TX 77365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |