Provider Demographics
NPI:1174737084
Name:GRUENES, STEPHANIE L (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:L
Last Name:GRUENES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13734 FIRST STREET
Mailing Address - Street 2:P.O. BOX 38
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308
Mailing Address - Country:US
Mailing Address - Phone:763-262-7645
Mailing Address - Fax:763-262-2345
Practice Address - Street 1:13734 FIRST STREET
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308
Practice Address - Country:US
Practice Address - Phone:763-262-7645
Practice Address - Fax:763-262-2345
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11331122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice