Healthcare Provider Details

I. General information

NPI: 1144335464
Provider Name (Legal Business Name): GRUENDEL EANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 5TH AVE
PITTSBURGH PA
15213-3310
US

IV. Provider business mailing address

3506 5TH AVE
PITTSBURGH PA
15213-3310
US

V. Phone/Fax

Practice location:
  • Phone: 412-621-0200
  • Fax: 412-621-9414
Mailing address:
  • Phone: 412-621-0200
  • Fax: 412-621-9414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS016567L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS024036L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS019246L
License Number StatePA

VIII. Authorized Official

Name: TINA FISHER
Title or Position: FRONT OFFICE/ INS. COORD
Credential:
Phone: 412-621-0200