Provider Demographics
NPI:1205975034
Name:GRUNBERGER, ZUZANA JANA (DDS)
Entity type:Individual
Prefix:
First Name:ZUZANA
Middle Name:JANA
Last Name:GRUNBERGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29105 BUCKINGHAM
Mailing Address - Street 2:SUITE #11
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-427-2222
Mailing Address - Fax:734-427-1766
Practice Address - Street 1:29105 BUCKINGHAM
Practice Address - Street 2:SUITE #11
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-427-2222
Practice Address - Fax:734-427-1766
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist