Individual
DR. MARK S GRUCELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
620 RIDGEWOOD XING, SUITE K, FAIRLAWN, OH 44333-3531
(330) 733-7911
(330) 376-5214
Mailing address
620 RIDGEWOOD XING, FAIRLAWN, OH 44333-3531
(330) 733-7911
(330) 376-5214
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30020854
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2086808
—
OH
Enumeration date
10/06/2006
Last updated
08/17/2009
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