Organization
DR. ROY L. GROB, INC
Active
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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