Provider Demographics
NPI: | 1912456401 |
---|---|
Name: | GRYSKWICZ LLC |
Entity Type: | Organization |
Organization Name: | GRYSKWICZ LLC |
Other - Org Name: | DENTURE SOLUTIONS LLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER/DENTURIST |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | SHANNON |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | GRYSKWICZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LD |
Authorized Official - Phone: | 207-985-0210 |
Mailing Address - Street 1: | 54 YORK ST |
Mailing Address - Street 2: | |
Mailing Address - City: | KENNEBUNK |
Mailing Address - State: | ME |
Mailing Address - Zip Code: | 04043-7157 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 207-985-0210 |
Mailing Address - Fax: | 207-985-8068 |
Practice Address - Street 1: | 54 YORK ST |
Practice Address - Street 2: | |
Practice Address - City: | KENNEBUNK |
Practice Address - State: | ME |
Practice Address - Zip Code: | 04043-7157 |
Practice Address - Country: | US |
Practice Address - Phone: | 207-985-0210 |
Practice Address - Fax: | 207-985-8068 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-09-26 |
Last Update Date: | 2016-09-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ME | 5007 | 122400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122400000X | Dental Providers | Denturist | Group - Single Specialty |