Provider Demographics
NPI:1174307656
Name:GROVE FAMILY MEDICINE-DPC
Entity type:Organization
Organization Name:GROVE FAMILY MEDICINE-DPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:801-920-5561
Mailing Address - Street 1:46499 PORTO BELLO CT
Mailing Address - Street 2:
Mailing Address - City:DRAYDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20630-3217
Mailing Address - Country:US
Mailing Address - Phone:801-920-5561
Mailing Address - Fax:
Practice Address - Street 1:46499 PORTO BELLO CT
Practice Address - Street 2:
Practice Address - City:DRAYDEN
Practice Address - State:MD
Practice Address - Zip Code:20630-3217
Practice Address - Country:US
Practice Address - Phone:801-920-5561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center