# DR. MARY GROTE

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

## Provider details

- **NPI number:** 1740336114
- **Authorized official:** DR. MARY GROTE DDS (OWNER)
- **Authorized official phone:** (920) 887-8423

## Contact information

- **Practice address:** 301 S ROOSEVELT DR, SUITE A, BEAVER DAM, WI 53916-2439
- **Practice address phone:** (920) 887-8423
- **Practice address fax:** (920) 887-8471
- **Mailing address:** 301 S ROOSEVELT DR, SUITE A, BEAVER DAM, WI 53916-2439
- **Mailing address phone:** (920) 887-8423
- **Mailing address fax:** (920) 887-8471

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2582-015 | WI | Yes |

## Other

- **Enumeration date:** 01/26/2007
- **Last updated:** 08/22/2020