Individual
CODY SHAWN GROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3011 N MICHIGAN ST, PITTSBURG, KS 66762-2546
(202) 319-8736
(620) 231-5062
Mailing address
PO BOX 1808, PITTSBURG, KS 66762-1808
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12891810-9922
UT
122300000X
Dentist
Primary
61967
KS
Other
Enumeration date
07/19/2022
Last updated
02/03/2023
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