Provider Demographics
NPI:1033105853
Name:GRUENBERG, ROBERT A (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:GRUENBERG
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 1:14315 E 465 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-2776
Mailing Address - Country:US
Mailing Address - Phone:918-342-5038
Mailing Address - Fax:918-341-9670
Practice Address - Street 1:133 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-4226
Practice Address - Country:US
Practice Address - Phone:918-342-3477
Practice Address - Fax:918-341-9670
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice