Provider Demographics
NPI:1912126012
Name:GRONCKI, MARIE E (DMD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:GRONCKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 HARLEYSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964
Mailing Address - Country:US
Mailing Address - Phone:215-721-8811
Mailing Address - Fax:215-721-5393
Practice Address - Street 1:390 HARLEYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964
Practice Address - Country:US
Practice Address - Phone:215-721-8811
Practice Address - Fax:215-721-5393
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS02959L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice