Individual
DR. MARK J. GRUNBERG
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3758 W CHICAGO AVE, CHICAGO, IL 60651-3823
(773) 276-6600
Mailing address
3758 W CHICAGO AVE, CHICAGO, IL 60651-3823
(773) 276-6600
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002071
—
IL
Enumeration date
06/14/2005
Last updated
07/09/2007
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