Provider Demographics
NPI:1285828178
Name:MICHAEL J. GRUBLER, DDS
Entity type:Organization
Organization Name:MICHAEL J. GRUBLER, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GRUBLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-233-7400
Mailing Address - Street 1:969 NATIONAL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6440
Mailing Address - Country:US
Mailing Address - Phone:304-233-7400
Mailing Address - Fax:304-233-4110
Practice Address - Street 1:969 NATIONAL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6440
Practice Address - Country:US
Practice Address - Phone:304-233-7400
Practice Address - Fax:304-233-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27161223G0001X
OH0187221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty