Provider Demographics
NPI:1740406099
Name:GRINDLING, KENNETH TRACY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:TRACY
Last Name:GRINDLING
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 1:3709 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3324
Mailing Address - Country:US
Mailing Address - Phone:248-858-2396
Mailing Address - Fax:248-852-1813
Practice Address - Street 1:3709 AUBURN ROAD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326
Practice Address - Country:US
Practice Address - Phone:248-858-2396
Practice Address - Fax:248-852-1813
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010129001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice