Provider Demographics
NPI:1457410433
Name:GRUENER, HANSROLF HILDEBRANDT (DDS)
Entity Type:Individual
Prefix:
First Name:HANSROLF
Middle Name:HILDEBRANDT
Last Name:GRUENER
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 1:830 METCALF ST
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284
Mailing Address - Country:US
Mailing Address - Phone:360-855-0351
Mailing Address - Fax:360-855-9357
Practice Address - Street 1:830 METCALF ST
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284
Practice Address - Country:US
Practice Address - Phone:360-855-0351
Practice Address - Fax:360-855-9357
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5312GROtherREGENCE
WA82145OtherLABOR & INDUSTRIES
WA5007604Medicaid
757623OtherUNITED CONCORDIA