Provider Demographics
NPI:1659443596
Name:GRUMET, JOSHUA T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:T
Last Name:GRUMET
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 1:111 N WABASH AVE STE 1820
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2973
Mailing Address - Country:US
Mailing Address - Phone:312-236-3633
Mailing Address - Fax:
Practice Address - Street 1:111 N WABASH AVE STE 1820
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2973
Practice Address - Country:US
Practice Address - Phone:312-236-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026399122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist