Provider Demographics
NPI:1104911080
Name:GRUBB, RICHARD VALIN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:VALIN
Last Name:GRUBB
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 1:203 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3244
Mailing Address - Country:US
Mailing Address - Phone:410-939-5800
Mailing Address - Fax:
Practice Address - Street 1:203 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3244
Practice Address - Country:US
Practice Address - Phone:410-939-5800
Practice Address - Fax:410-939-1511
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD59071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice