Provider Demographics
NPI:1144399684
Name:JOHN C GRABOW DDS LTD
Entity Type:Organization
Organization Name:JOHN C GRABOW DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GRABOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-754-8090
Mailing Address - Street 1:3112 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475-1166
Mailing Address - Country:US
Mailing Address - Phone:708-754-8090
Mailing Address - Fax:708-754-8433
Practice Address - Street 1:3112 UNION AVE
Practice Address - Street 2:
Practice Address - City:STEGER
Practice Address - State:IL
Practice Address - Zip Code:60475-1166
Practice Address - Country:US
Practice Address - Phone:708-754-8090
Practice Address - Fax:708-754-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental