Provider Demographics
NPI:1164986154
Name:GRABOVICH, TY ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:ALEXANDER
Last Name:GRABOVICH
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 1:1214 WHITESIDE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WARTRACE
Mailing Address - State:TN
Mailing Address - Zip Code:37183-3029
Mailing Address - Country:US
Mailing Address - Phone:931-224-0088
Mailing Address - Fax:
Practice Address - Street 1:790 NW BROAD ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2766
Practice Address - Country:US
Practice Address - Phone:615-867-6360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist