Provider Demographics
NPI:1093970113
Name:GRABOWSKI, MICHAEL JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:GRABOWSKI
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 1:2200 MARQUETTE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1547
Mailing Address - Country:US
Mailing Address - Phone:815-223-3321
Mailing Address - Fax:
Practice Address - Street 1:2200 MARQUETTE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1547
Practice Address - Country:US
Practice Address - Phone:815-223-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021824122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist