Individual
CODY EUGENE GRONSTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
240 E 23RD ST, MITCHELL, SD 57301-6440
(605) 996-1316
(605) 996-6629
Mailing address
240 E 23RD ST, MITCHELL, SD 57301-6440
(605) 996-1316
(605) 996-6629
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1060
SD
Other
Enumeration date
07/01/2014
Last updated
07/01/2014
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