Healthcare Provider Details

I. General information

NPI: 1922162635
Provider Name (Legal Business Name): GRETCHEN MARY VONRUEDEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 BECKER AVE SW
WILLMAR MN
56201
US

IV. Provider business mailing address

301 BECKER AVE SW
WILLMAR MN
56201-3302
US

V. Phone/Fax

Practice location:
  • Phone: 320-214-2620
  • Fax: 320-214-2630
Mailing address:
  • Phone: 320-214-2620
  • Fax: 320-214-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10302
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: