Provider Demographics
NPI:1568520013
Name:GRUENDEMAN, GARY (DDS, PC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:GRUENDEMAN
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6833 DIDRIKSON LN
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1482
Mailing Address - Country:US
Mailing Address - Phone:630-637-0303
Mailing Address - Fax:
Practice Address - Street 1:3540 SEVEN BRIDGES DR
Practice Address - Street 2:SUITE 220
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1221
Practice Address - Country:US
Practice Address - Phone:630-663-9961
Practice Address - Fax:630-663-9961
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics