Provider Demographics
NPI:1184738304
Name:GRUNWALD, ERICA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:ANN
Last Name:GRUNWALD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:ANN
Other - Last Name:MIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:22905 W MAIN ST # 571
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-3225
Mailing Address - Country:US
Mailing Address - Phone:586-784-9033
Mailing Address - Fax:586-785-5644
Practice Address - Street 1:22905 W MAIN ST # 571
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005-3225
Practice Address - Country:US
Practice Address - Phone:586-784-9033
Practice Address - Fax:586-785-5644
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010181411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice