# MCDONALD & GRUCHALLA, D.D.S., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053453688
- **Authorized official:** DR. STEPHANIE GUY GRUCHALLA DDS (CO-OWNER, DENTIST)
- **Authorized official phone:** (701) 235-1261

## Contact information

- **Practice address:** 1231 27TH ST S, FARGO, ND 58103-8722
- **Practice address phone:** (701) 235-1261
- **Mailing address:** 1231 27TH ST S, FARGO, ND 58103-8722
- **Mailing address phone:** (701) 235-1261

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1957 | ND | Yes |

## Other

- **Enumeration date:** 02/12/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 41376 | — | ND |