Provider Demographics
NPI:1548373673
Name:GREUNKE, GARY ARTHUR (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ARTHUR
Last Name:GREUNKE
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 1:327 BUCKEYE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1423
Mailing Address - Country:US
Mailing Address - Phone:419-734-5574
Mailing Address - Fax:419-734-9884
Practice Address - Street 1:327 BUCKEYE BLVD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1423
Practice Address - Country:US
Practice Address - Phone:419-734-5574
Practice Address - Fax:419-734-9884
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist