Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 5151 | CO |
NPI | 1730180506 |
---|---|
Provider Name | Dr. Forrest D W Groves III |
First Address | Boulder, CO 80301-2364 |
Second Address | Boulder, CO 80301-2364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 02/05/2008 |