Provider Demographics
NPI:1073867222
Name:GRUNTZ, RICHARD DAVID III (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAVID
Last Name:GRUNTZ
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CRYSTAL SQUARE ARC STE L
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3323
Mailing Address - Country:US
Mailing Address - Phone:571-233-5023
Mailing Address - Fax:
Practice Address - Street 1:1600 CRYSTAL SQUARE ARC STE L
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3323
Practice Address - Country:US
Practice Address - Phone:703-412-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014132441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice