Individual
ETHAN J GROEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
167 E 200 N STE 3, LOGAN, UT 84321-4049
(435) 363-3584
Mailing address
265 S 375 W, PROVIDENCE, UT 84332-9308
(385) 630-3788
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14290602-9923
UT
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
UT
Other
Enumeration date
05/20/2026
Last updated
06/04/2026
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