Provider Demographics
NPI:1053453688
Name:MCDONALD & GRUCHALLA, D.D.S., P.C.
Entity Type:Organization
Organization Name:MCDONALD & GRUCHALLA, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:GRUCHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-235-1261
Mailing Address - Street 1:1231 27TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8722
Mailing Address - Country:US
Mailing Address - Phone:701-235-1261
Mailing Address - Fax:
Practice Address - Street 1:1231 27TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8722
Practice Address - Country:US
Practice Address - Phone:701-235-1261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND19571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41376Medicaid