Provider Demographics
NPI:1942401047
Name:GRUNBERG, JENNY ADINA (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:ADINA
Last Name:GRUNBERG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8814 W H AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8505
Mailing Address - Country:US
Mailing Address - Phone:269-375-4489
Mailing Address - Fax:269-657-4530
Practice Address - Street 1:54055 COUNTY RD 653
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079
Practice Address - Country:US
Practice Address - Phone:269-657-3900
Practice Address - Fax:269-657-4530
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI114421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice