Provider Demographics
NPI:1619039872
Name:GRUBLER, JOSEPH B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:B
Last Name:GRUBLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 NATIONAL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6440
Mailing Address - Country:US
Mailing Address - Phone:304-233-3020
Mailing Address - Fax:304-230-2001
Practice Address - Street 1:969 NATIONAL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6440
Practice Address - Country:US
Practice Address - Phone:304-233-3020
Practice Address - Fax:304-230-2001
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134628000Medicaid