Provider Demographics
NPI:1487263067
Name:GRUSKIN, LORI STEPHANIE (DMD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:STEPHANIE
Last Name:GRUSKIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11135 LOST CREEK TER APT 104
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9371
Mailing Address - Country:US
Mailing Address - Phone:954-479-8983
Mailing Address - Fax:
Practice Address - Street 1:1602 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1440
Practice Address - Country:US
Practice Address - Phone:941-708-6504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL252961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice