Provider Demographics
NPI:1043358534
Name:GROMIS, TROY A (DDS)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:A
Last Name:GROMIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 HAMNER AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860
Mailing Address - Country:US
Mailing Address - Phone:951-735-0149
Mailing Address - Fax:951-735-6271
Practice Address - Street 1:1675 HAMNER AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860
Practice Address - Country:US
Practice Address - Phone:951-735-0149
Practice Address - Fax:951-735-6271
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA409401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice