Provider Demographics
NPI:1114977303
Name:GABRISH GRABOVAC, LISA M (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:GABRISH GRABOVAC
Suffix:
Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:1495 POPE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-5301
Mailing Address - Country:US
Mailing Address - Phone:219-926-1068
Mailing Address - Fax:219-929-1944
Practice Address - Street 1:1495 POPE CT
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-5301
Practice Address - Country:US
Practice Address - Phone:219-926-1068
Practice Address - Fax:219-929-1944
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120089711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100209830Medicaid
749490OtherUNITED CONCORDIA INS. CO.