Provider Demographics
NPI:1386807345
Name:GRABLE, GEORDEE P
Entity type:Individual
Prefix:DR
First Name:GEORDEE
Middle Name:P
Last Name:GRABLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 TOWNE PLZ
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-7910
Mailing Address - Country:US
Mailing Address - Phone:570-836-6565
Mailing Address - Fax:570-836-9648
Practice Address - Street 1:513 TOWNE PLZ
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-7910
Practice Address - Country:US
Practice Address - Phone:570-836-6565
Practice Address - Fax:570-836-9648
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-0237231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice