Provider Demographics
NPI:1134365554
Name:GRONSTEN-MAIER DENTAL PROF. LLC
Entity type:Organization
Organization Name:GRONSTEN-MAIER DENTAL PROF. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GRONSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-996-1316
Mailing Address - Street 1:240 E. 23RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301
Mailing Address - Country:US
Mailing Address - Phone:605-996-1316
Mailing Address - Fax:605-996-6629
Practice Address - Street 1:240 E. 23RD AVENUE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301
Practice Address - Country:US
Practice Address - Phone:605-996-1316
Practice Address - Fax:605-996-6629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty