Provider Demographics
NPI:1174953277
Name:GRUVER, DEXTER (LD)
Entity type:Individual
Prefix:
First Name:DEXTER
Middle Name:
Last Name:GRUVER
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 SOUNDVIEW DR STE A102
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-2057
Mailing Address - Country:US
Mailing Address - Phone:208-403-9694
Mailing Address - Fax:
Practice Address - Street 1:5800 SOUNDVIEW DR STE A102
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2057
Practice Address - Country:US
Practice Address - Phone:208-403-9694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN 60404431122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist