Provider Demographics
NPI:1366435992
Name:GROSS, ALAN MITCHELL (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MITCHELL
Last Name:GROSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 PHOENIX DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-6307
Mailing Address - Country:US
Mailing Address - Phone:817-244-1700
Mailing Address - Fax:
Practice Address - Street 1:3317 PHOENIX DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6307
Practice Address - Country:US
Practice Address - Phone:817-244-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice