Provider Demographics
NPI:1144335464
Name:GRUENDEL EANS PC
Entity type:Organization
Organization Name:GRUENDEL EANS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE/ INS. COORD
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-621-0200
Mailing Address - Street 1:3506 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3310
Mailing Address - Country:US
Mailing Address - Phone:412-621-0200
Mailing Address - Fax:412-621-9414
Practice Address - Street 1:3506 5TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3310
Practice Address - Country:US
Practice Address - Phone:412-621-0200
Practice Address - Fax:412-621-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016567L1223G0001X
PADS024036L1223P0700X
332B00000X
PADS019246L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS019246LOtherSTATE DENTAL LICENSE
PADS024036LOtherSTATE DENTAL LICENSE
PADS042054OtherSTATE DENTAL LICENSE
PADS039211OtherSTATE DENTAL LICENSE