Organization
DR. ROY L. GROB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROY LOUIS GROB JR. D.D.S., M.S. (ORTHODONTIST)
(985) 626-4779
Entity
Organization
Contact information
Practice address
2245 11TH ST, SUITE C, MANDEVILLE, LA 70471-6497
(985) 626-4779
(985) 626-4779
Mailing address
2245 11TH ST, SUITE C, MANDEVILLE, LA 70471-6497
(985) 626-4779
(985) 626-4779
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2058
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0082058
—
LA
Enumeration date
08/16/2007
Last updated
08/16/2007
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