| Grove Street Dental Pc | |
|
175 Newark Ave Jersey City NJ 07302 | |
| (201) 200-0222 | |
| (201) 435-7678 |
| Full Name | Grove Street Dental Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 175 Newark Ave, Jersey City, New Jersey |
| Authorized Official Name and Position | Vladimir Dranovsky (PRESIDENT) |
| Authorized Official Contact | 2012000222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grove Street Dental Pc Po Box 345 Jersey City NJ 07303 Ph: (201) 200-0222 | Grove Street Dental Pc 175 Newark Ave Jersey City NJ 07302 Ph: (201) 200-0222 |
| NPI Number | 1184737496 |
|---|---|
| Provider Enumeration Date | 08/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184737496 | NPI | - | NPPES |
| 5170907 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DI20129 (New Jersey) | Primary |
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