Healthcare Provider Details

I. General information

NPI: 1285648840
Provider Name (Legal Business Name): RONNIE L GRUNDSET DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 NW 27TH CT
GAINESVILLE FL
32606-6590
US

IV. Provider business mailing address

4910 NW 27TH CT
GAINESVILLE FL
32606-6590
US

V. Phone/Fax

Practice location:
  • Phone: 352-371-3300
  • Fax: 352-374-9247
Mailing address:
  • Phone: 352-371-3300
  • Fax: 352-374-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN9219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: