Provider Demographics
NPI:1477662369
Name:GRABOW, JAMES A (DDS, MS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:GRABOW
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MORNING STAR DR STE A
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9249
Mailing Address - Country:US
Mailing Address - Phone:209-532-5788
Mailing Address - Fax:209-532-5834
Practice Address - Street 1:800 MORNING STAR DR STE A
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9249
Practice Address - Country:US
Practice Address - Phone:209-532-5788
Practice Address - Fax:209-532-5834
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics