Provider Demographics
NPI:1174052070
Name:GROCE, BOONE HAYNES (DMD)
Entity type:Individual
Prefix:DR
First Name:BOONE
Middle Name:HAYNES
Last Name:GROCE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 NC HIGHWAY 16 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-3050
Mailing Address - Country:US
Mailing Address - Phone:828-459-1400
Mailing Address - Fax:
Practice Address - Street 1:311 NC HIGHWAY 16 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-3050
Practice Address - Country:US
Practice Address - Phone:828-459-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist