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Individual

DANTE J GRASSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
602 W. LOCUST ST., BOONVILLE, IN 47601
(812) 897-3470
(812) 897-0068
Mailing address
PO BOX 167, BOONVILLE, IN 47601-0167
(812) 897-3470
(812) 897-0068

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013015A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
753139523
DELTA DENTAL
IN
01
753139523
DENTAQUEST
05
753139523
IN
Enumeration date
07/30/2018
Last updated
07/30/2018
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