Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 10193 | NC |
N | 1223P0221X | Pediatric Dentist | 10193 | NC |
N | 1223P0300X | Periodontist | 10193 | NC |
NPI | 1073708418 |
---|---|
Provider Name | Dr. Sara G Grossi |
First Address | Greenville, NC 27834-0527 |
Second Address | Greenville, NC 27834-0527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2007 |
Last Update Date | 27/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5907748 | (05) | NC |