Individual
DR. PHILIP M GROSNICK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
319 N 2ND ST, WATERTOWN, WI 53094-3713
(920) 261-2828
Mailing address
319 N 2ND ST, WATERTOWN, WI 53094-3713
(920) 261-2828
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2831-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33432700
—
WI
Enumeration date
05/04/2006
Last updated
07/08/2007
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