# DOUGLAS M GROSMARK DMD INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043639230
- **Authorized official:** ELAINE LOPEZ (OFFICE ADMINISTRATOR)
- **Authorized official phone:** (619) 286-1181

## Contact information

- **Practice address:** 6398 DEL CERRO BLVD STE 1, SAN DIEGO, CA 92120-4760
- **Practice address phone:** (619) 286-1181
- **Practice address fax:** (619) 286-1438
- **Mailing address:** 6398 DEL CERRO BLVD STE 1, SAN DIEGO, CA 92120-4760
- **Mailing address phone:** (619) 286-1181
- **Mailing address fax:** (619) 286-1438

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | CA | Yes |

## Other

- **Enumeration date:** 04/15/2014
- **Last updated:** 04/15/2014