Individual
DR. MITCHELL GRUZMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4410 W 16TH AVE STE 52, HIALEAH, FL 33012-7193
(305) 825-9899
Mailing address
7225 PORT MARNOCK DR, HIALEAH, FL 33015-2061
(847) 757-8033
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019030822
IL
1223P0221X
Pediatric Dentistry
Primary
DN24566
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114189300
—
FL
Enumeration date
07/14/2016
Last updated
12/20/2022
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