Provider Demographics
NPI:1023174554
Name:ANDREW D. GRUVER DDS AND ASSOCIATES PA
Entity type:Organization
Organization Name:ANDREW D. GRUVER DDS AND ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:GRUVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-766-2744
Mailing Address - Street 1:407 CRAIN HWY S
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3670
Mailing Address - Country:US
Mailing Address - Phone:410-766-2744
Mailing Address - Fax:
Practice Address - Street 1:407 CRAIN HWY S
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3670
Practice Address - Country:US
Practice Address - Phone:410-766-2744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7170122300000X
MD13735122300000X
MD57551223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty