Provider Demographics
NPI:1578296653
Name:GRABOWSKI, GREGORY (DMD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:GRABOWSKI
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 1:217 CAVALLINI DR
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-1467
Mailing Address - Country:US
Mailing Address - Phone:860-707-4199
Mailing Address - Fax:
Practice Address - Street 1:2785 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5101
Practice Address - Country:US
Practice Address - Phone:941-625-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist