Grucella, Mark S
Grucella, Mark S is an individual health care provider with primary practice located at 620 Ridgewood Xing Suite K, Fairlawn OH 44333-3531. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Grucella, Mark S can be contacted via phone (330) 733-7911.Contact Information
Primary practice address
620 Ridgewood Xing Suite K
Fairlawn OH 44333-3531
Phone: (330) 733-7911
Fax: (330) 376-5214
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 30020854 | Ohio |
Profile Details
| NPI number | 1184711871 |
|---|---|
| LBN Legal business name | Grucella, Mark S |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 6th, 2006 |
| Last updated | Aug 17th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184711871 | NPPES |
| Ohio | MEDICAID | 2086808 |
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