Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0401415656 | VA |
N | 1223D0001X | Dental Public Health | 0401515656 | VA |
Y | 1223G0001X | General Practice | 0401415656 | VA |
Y | 213EG0000X | General Practice | 0401415656 | VA |
NPI | 1639608441 |
---|---|
Provider Name | Dr. Natasha Amy Grover |
First Address | Reston, VA 20190-3354 |
Second Address | South Hill, VA 23950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 22/08/2018 |