Provider Demographics
NPI:1396332425
Name:GRITTNERS DENTAL PLLC
Entity type:Organization
Organization Name:GRITTNERS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JADILYN
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:GRITTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-483-6144
Mailing Address - Street 1:1488 BREDA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2607
Mailing Address - Country:US
Mailing Address - Phone:612-483-6144
Mailing Address - Fax:
Practice Address - Street 1:670 CLEVELAND AVE S STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1218
Practice Address - Country:US
Practice Address - Phone:612-483-6144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental