Provider Demographics
NPI:1144246935
Name:GRUNSPERGER, RODICA STELA (MD,DDS)
Entity type:Individual
Prefix:DR
First Name:RODICA
Middle Name:STELA
Last Name:GRUNSPERGER
Suffix:
Gender:F
Credentials:MD,DDS
Other - Prefix:DR
Other - First Name:RODICA
Other - Middle Name:STELA
Other - Last Name:BONATIU-GRUNSPERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD,DDS
Mailing Address - Street 1:456 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4458
Mailing Address - Country:US
Mailing Address - Phone:718-604-9417
Mailing Address - Fax:718-604-9417
Practice Address - Street 1:1805 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7133
Practice Address - Country:US
Practice Address - Phone:917-505-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01110085Medicaid