Provider Demographics
NPI:1598969511
Name:GRZECH, ALBERT SAMUEL JR (DDS)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:SAMUEL
Last Name:GRZECH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:AL
Other - Middle Name:
Other - Last Name:GRZECH
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7304 E FURNACE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-7056
Mailing Address - Country:US
Mailing Address - Phone:410-424-3552
Mailing Address - Fax:410-424-3552
Practice Address - Street 1:7304 E FURNACE BRANCH RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7056
Practice Address - Country:US
Practice Address - Phone:410-424-3552
Practice Address - Fax:410-424-3552
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist