Provider Demographics
NPI:1801216130
Name:ROBERT D. GREW DMD, INC.
Entity Type:Organization
Organization Name:ROBERT D. GREW DMD, INC.
Other - Org Name:ROBERT D. GREW DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-653-4079
Mailing Address - Street 1:10163 SE SUNNYSIDE ROAD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-653-4079
Mailing Address - Fax:503-653-9902
Practice Address - Street 1:10163 SE SUNNYSIDE ROAD
Practice Address - Street 2:SUITE 414
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-653-4079
Practice Address - Fax:503-653-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty