Provider Demographics
NPI:1609645548
Name:JOSHUA GRUBER, DDS, LLC
Entity Type:Organization
Organization Name:JOSHUA GRUBER, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-779-5111
Mailing Address - Street 1:204 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROUGE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537
Mailing Address - Country:US
Mailing Address - Phone:541-779-5111
Mailing Address - Fax:
Practice Address - Street 1:204 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROUGE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537
Practice Address - Country:US
Practice Address - Phone:541-779-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty