Provider Demographics
NPI:1194879544
Name:GRUBBS, MARION CLAYTON (DMD)
Entity type:Individual
Prefix:DR
First Name:MARION
Middle Name:CLAYTON
Last Name:GRUBBS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2189 HENRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-2125
Mailing Address - Country:US
Mailing Address - Phone:601-922-2260
Mailing Address - Fax:601-922-2267
Practice Address - Street 1:2189 HENRY HILL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-2125
Practice Address - Country:US
Practice Address - Phone:601-922-2260
Practice Address - Fax:601-922-2267
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist