Provider Demographics
NPI:1861134611
Name:DR. JENNY GRUNBERG DMD
Entity type:Organization
Organization Name:DR. JENNY GRUNBERG DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-657-3900
Mailing Address - Street 1:54055 COUNTY ROAD 653
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-9486
Mailing Address - Country:US
Mailing Address - Phone:269-657-3900
Mailing Address - Fax:
Practice Address - Street 1:54055 COUNTY ROAD 653
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-9486
Practice Address - Country:US
Practice Address - Phone:269-657-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty