Provider Demographics
NPI:1609898188
Name:GRONNER, BRUCE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:C
Last Name:GRONNER
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 1:46 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1238
Mailing Address - Country:US
Mailing Address - Phone:312-642-0066
Mailing Address - Fax:312-642-1398
Practice Address - Street 1:46 E OAK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1238
Practice Address - Country:US
Practice Address - Phone:312-642-0066
Practice Address - Fax:312-642-1398
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A13828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist