Provider Demographics
NPI:1790469591
Name:GRIBBINS, JOHNROSS WALSH
Entity Type:Individual
Prefix:
First Name:JOHNROSS
Middle Name:WALSH
Last Name:GRIBBINS
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 1:7303 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1903
Mailing Address - Country:US
Mailing Address - Phone:850-283-0033
Mailing Address - Fax:
Practice Address - Street 1:7303 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1903
Practice Address - Country:US
Practice Address - Phone:850-283-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist