Individual
DAVID ANTHONY GROAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1300 KURT DR STE 101, ANGELS CAMP, CA 95222-9324
(209) 736-0458
(209) 736-4858
Mailing address
1300 KURT DR STE 101, ANGELS CAMP, CA 95222-9324
(209) 736-0458
(209) 736-4858
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
33771
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33771
STATE DENTAL LICENSE
CA
Enumeration date
06/07/2006
Last updated
08/09/2010
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