Provider Demographics
NPI:1851854236
Name:PATRICK R. GRUBE DDS PC
Entity Type:Organization
Organization Name:PATRICK R. GRUBE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-642-0549
Mailing Address - Street 1:211 66TH ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-2040
Mailing Address - Country:US
Mailing Address - Phone:757-642-0549
Mailing Address - Fax:
Practice Address - Street 1:1245 CEDAR RD STE L
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7141
Practice Address - Country:US
Practice Address - Phone:757-382-9336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty