Provider Demographics
NPI:1871232033
Name:GROBBELAAR, HENK JOHANNES (DMD)
Entity Type:Individual
Prefix:
First Name:HENK
Middle Name:JOHANNES
Last Name:GROBBELAAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12217 GREYMORE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2494
Mailing Address - Country:US
Mailing Address - Phone:704-743-7522
Mailing Address - Fax:
Practice Address - Street 1:810 BRAYDEN PKWY
Practice Address - Street 2:STE 109
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708
Practice Address - Country:US
Practice Address - Phone:803-810-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130251223G0001X
SCDGD.101741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice