Basic Information
| Provider Information | |||||||||
| NPI: | 1356328306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRONET | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | BLDG 38717, 38TH STREET | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | FT GORDON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309055660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067876927 | ||||||||
| FaxNumber: | 7067872082 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG 38717, 38TH STREET | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | FT GORDON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309055660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067876927 | ||||||||
| FaxNumber: | 7067872082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 8403 | OR | X | Dental Providers | Dentist | 122300000X | 6505 | KY | X | Dental Providers | Dentist | 122300000X | DE00008636 | WA | X | Dental Providers | Dentist | 122300000X | 12009306A | IN | X | Dental Providers | Dentist | 122300000X | DS024690L | PA | X | Dental Providers | Dentist | 1223P0700X | 8403 | OR | X | Dental Providers | Dentist | Prosthodontics | 1223P0700X | 6505 | KY | X | Dental Providers | Dentist | Prosthodontics | 1223P0700X | DE00008636 | WA | X | Dental Providers | Dentist | Prosthodontics | 1223P0700X | 12009306A | IN | X | Dental Providers | Dentist | Prosthodontics | 1223P0700X | DS024690L | PA | X | Dental Providers | Dentist | Prosthodontics |
No ID Information.