Provider Demographics
NPI:1740457167
Name:GRASK, ROBERT E (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:GRASK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:655 WALNUT ST
Mailing Address - Street 2:SUITE 134B
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3906
Mailing Address - Country:US
Mailing Address - Phone:515-243-6311
Mailing Address - Fax:515-244-1572
Practice Address - Street 1:655 WALNUT ST
Practice Address - Street 2:SUITE 134B
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3906
Practice Address - Country:US
Practice Address - Phone:515-243-6311
Practice Address - Fax:515-244-1572
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA69171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24933OtherBC BS FEP
IA1639355OtherUNITED CONCORDIA
IA0207498Medicaid
IA001771OtherBLUE DENTAL & BC BS