Provider Demographics
NPI:1134280654
Name:GRUBER, EDWARD H (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:GRUBER
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 1:4022 NILES ST # B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4630
Mailing Address - Country:US
Mailing Address - Phone:661-871-3736
Mailing Address - Fax:661-871-7417
Practice Address - Street 1:4022 NILES ST # B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4630
Practice Address - Country:US
Practice Address - Phone:661-871-3736
Practice Address - Fax:661-871-7417
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3302002Medicaid
CAB3302001OtherHEALTHY FAMILIES PROVIDER