Provider Demographics
NPI:1326129305
Name:GRUBERG, JOSEPH M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:GRUBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7485 HUNTSMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-1648
Mailing Address - Country:US
Mailing Address - Phone:703-569-4422
Mailing Address - Fax:703-569-0882
Practice Address - Street 1:7485 HUNTSMAN BLVD
Practice Address - Street 2:HUNTSMAN BOULEVARD
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-1648
Practice Address - Country:US
Practice Address - Phone:703-569-4422
Practice Address - Fax:703-569-0882
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist