Provider Demographics
NPI:1194842468
Name:GRENIUK-WIONCEK, KRISTAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTAL
Middle Name:
Last Name:GRENIUK-WIONCEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 WOODVALE TRL
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8149
Mailing Address - Country:US
Mailing Address - Phone:734-634-4077
Mailing Address - Fax:734-525-2505
Practice Address - Street 1:OTSEGO DENTAL GROUP
Practice Address - Street 2:785 M-32
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:48735-4873
Practice Address - Country:US
Practice Address - Phone:989-448-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI161401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice