Provider Demographics
NPI:1932319423
Name:GRAUER-KUCHTA DENTAL AS
Entity Type:Organization
Organization Name:GRAUER-KUCHTA DENTAL AS
Other - Org Name:COMPLETE HEALTH DENTISTRY OF PARK RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KUCHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-696-3240
Mailing Address - Street 1:101 S WASHINGTON ST
Mailing Address - Street 2:SUITE 135
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4200
Mailing Address - Country:US
Mailing Address - Phone:847-696-3240
Mailing Address - Fax:
Practice Address - Street 1:101 S WASHINGTON AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4200
Practice Address - Country:US
Practice Address - Phone:847-696-3240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty