Provider Demographics
NPI:1134469869
Name:DAVID C. GRUBER, DDS, MS, PC
Entity Type:Organization
Organization Name:DAVID C. GRUBER, DDS, MS, PC
Other - Org Name:GRAND RAPIDS ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:616-784-5800
Mailing Address - Street 1:1100 4 MILE RD NW
Mailing Address - Street 2:SUITE C
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49544-7397
Mailing Address - Country:US
Mailing Address - Phone:616-784-5800
Mailing Address - Fax:616-784-5801
Practice Address - Street 1:1100 4 MILE RD NW
Practice Address - Street 2:SUITE C
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49544-7397
Practice Address - Country:US
Practice Address - Phone:616-784-5800
Practice Address - Fax:616-784-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010148391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty