Provider Demographics
NPI:1346661790
Name:GRILLO AND ROBECK PLLC
Entity Type:Organization
Organization Name:GRILLO AND ROBECK PLLC
Other - Org Name:GRILLO ROBECK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:GRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-826-4050
Mailing Address - Street 1:PO BOX 1841
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-1841
Mailing Address - Country:US
Mailing Address - Phone:609-826-4050
Mailing Address - Fax:
Practice Address - Street 1:739 HAUSSLER RD
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9547
Practice Address - Country:US
Practice Address - Phone:509-826-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-01
Last Update Date:2014-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty