Provider Demographics
NPI:1376670364
Name:GRUNDER, RICHARD WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WAYNE
Last Name:GRUNDER
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 1:2634 100TH ST
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:IA
Mailing Address - Zip Code:52778-9550
Mailing Address - Country:US
Mailing Address - Phone:563-732-4024
Mailing Address - Fax:
Practice Address - Street 1:501 NINTH AVENUE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:IA
Practice Address - Zip Code:52747-0066
Practice Address - Country:US
Practice Address - Phone:563-785-4541
Practice Address - Fax:563-785-4687
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA70311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice