Provider Demographics
NPI:1962518241
Name:GRONEMYER, JAMES ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:GRONEMYER
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 1:913 A ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97458-1334
Mailing Address - Country:US
Mailing Address - Phone:541-572-5511
Mailing Address - Fax:541-572-3733
Practice Address - Street 1:913 A ST
Practice Address - Street 2:
Practice Address - City:MYRTLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97458-1334
Practice Address - Country:US
Practice Address - Phone:541-572-5511
Practice Address - Fax:541-572-3733
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR217398OtherOREGON HEALTH PLAN