Individual
GORDON ERNEST GRUEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
780 RIDGE LAKE BLVD, SUITE 101, MEMPHIS, TN 38120-9426
(901) 682-8431
(901) 682-2345
Mailing address
780 RIDGE LAKE BLVD, SUITE 101, MEMPHIS, TN 38120-9426
(901) 682-8431
(901) 682-2345
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
DS 1783
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007914
BLUE CROSS BLUE SHIELD
TN
Enumeration date
08/21/2006
Last updated
07/08/2007
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