Provider Demographics
NPI:1194807974
Name:GIERUCKI, MAUREEN MARLENE (DDS)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:MARLENE
Last Name:GIERUCKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49094-1100
Mailing Address - Country:US
Mailing Address - Phone:517-741-4565
Mailing Address - Fax:517-741-8912
Practice Address - Street 1:715 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:MI
Practice Address - Zip Code:49094-1100
Practice Address - Country:US
Practice Address - Phone:517-741-4565
Practice Address - Fax:517-741-8912
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010181271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice