Provider Demographics
NPI:1235328469
Name:GRUEN, TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:GRUEN
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 1:2165 WEST ST
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3856
Mailing Address - Country:US
Mailing Address - Phone:901-754-0540
Mailing Address - Fax:901-754-0621
Practice Address - Street 1:2165 WEST ST
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3856
Practice Address - Country:US
Practice Address - Phone:901-754-0540
Practice Address - Fax:901-754-0621
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist