Provider Demographics
NPI:1285648840
Name:GRUNDSET, RONNIE L (DMD)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:L
Last Name:GRUNDSET
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 NW 27TH CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6590
Mailing Address - Country:US
Mailing Address - Phone:352-371-3300
Mailing Address - Fax:352-374-9247
Practice Address - Street 1:4910 NW 27TH CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6590
Practice Address - Country:US
Practice Address - Phone:352-371-3300
Practice Address - Fax:352-374-9247
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN92191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry