Healthcare Provider Details

I. General information

NPI: 1538269626
Provider Name (Legal Business Name): GREGORY DAVID GRUCELLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 PORTAGE TRAIL
CUYAHOGA FALLS OH
44223
US

IV. Provider business mailing address

1822 PORTAGE TRAIL
CUYAHOGA FALLS OH
44223
US

V. Phone/Fax

Practice location:
  • Phone: 330-928-6226
  • Fax: 330-928-0262
Mailing address:
  • Phone: 330-928-6226
  • Fax: 330-928-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30014434
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: