Provider Demographics
NPI:1104065416
Name:EDWARD H. GRUBER, DDS
Entity type:Organization
Organization Name:EDWARD H. GRUBER, DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-587-7645
Mailing Address - Street 1:3612 COFFEE RD
Mailing Address - Street 2:A
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5083
Mailing Address - Country:US
Mailing Address - Phone:661-587-7645
Mailing Address - Fax:661-587-7656
Practice Address - Street 1:3612 COFFEE RD
Practice Address - Street 2:A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5083
Practice Address - Country:US
Practice Address - Phone:661-587-7645
Practice Address - Fax:661-587-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental