Provider Demographics
NPI:1295983351
Name:GRUVER, ANDREW D (DDS, FAGD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:GRUVER
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:DEAN
Other - Last Name:GRUVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, FAGD
Mailing Address - Street 1:810 LANDMARK DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4987
Mailing Address - Country:US
Mailing Address - Phone:410-766-2744
Mailing Address - Fax:
Practice Address - Street 1:810 LANDMARK DR
Practice Address - Street 2:SUITE 114
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4987
Practice Address - Country:US
Practice Address - Phone:410-766-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
122300000X DENTISTOtherTAXONOMIES
MD7170OtherLICENSE #