Provider Demographics
NPI:1598983389
Name:GRABIEC, EDWARD J
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:GRABIEC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 RUSSET DR
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-2539
Mailing Address - Country:US
Mailing Address - Phone:715-344-6052
Mailing Address - Fax:
Practice Address - Street 1:420 3RD ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4350
Practice Address - Country:US
Practice Address - Phone:715-424-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5904-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist