Individual
DR. ROBERT ALBERT GROSSKLAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
111 BEAVER GRADE, NI M& I PUU, LAPWAI, ID 83540
(208) 843-2271
(208) 843-2658
Mailing address
2415 15TH ST, LEWISTON, ID 83501
(208) 743-5058
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1749
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2513900
—
WA
05
—
5065008
—
ID
Enumeration date
05/03/2007
Last updated
07/08/2007
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