Provider Demographics
NPI:1548335037
Name:GROSSER, JEFFREY WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:GROSSER
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:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578-0097
Mailing Address - Country:US
Mailing Address - Phone:207-882-6843
Mailing Address - Fax:
Practice Address - Street 1:64 WATER ST
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578-0097
Practice Address - Country:US
Practice Address - Phone:207-882-6843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME31031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice