Provider Demographics
NPI:1083446157
Name:GRUHLER, COLTON (DDS)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:
Last Name:GRUHLER
Suffix:
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 1:5 RICO WAY APT 103
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-1246
Mailing Address - Country:US
Mailing Address - Phone:530-262-8824
Mailing Address - Fax:
Practice Address - Street 1:1730 NOVATO BLVD STE A
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3048
Practice Address - Country:US
Practice Address - Phone:415-450-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1105861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice