Organization
GROSSE DMD INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GINA LEIGH GROSSE D.M.D. (GENERAL DENTIST)
(309) 472-0645
Entity
Organization
Contact information
Practice address
3939 W FULLERTON AVE, CHICAGO, IL 60647-2243
(773) 235-0000
Mailing address
849 N FRANKLIN ST, UNIT 1104, CHICAGO, IL 60610-8793
(309) 472-0645
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019027794
IL
Other
Enumeration date
11/02/2010
Last updated
11/02/2010
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