Provider Demographics
NPI:1952326639
Name:WROBLESKI, GREG JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:JOSEPH
Last Name:WROBLESKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MORGANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4375
Mailing Address - Country:US
Mailing Address - Phone:304-363-2020
Mailing Address - Fax:304-363-8021
Practice Address - Street 1:1030 MORGANTOWN AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4375
Practice Address - Country:US
Practice Address - Phone:304-363-2020
Practice Address - Fax:304-363-8021
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2027-561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVGR9287591OtherMEDICARE GROUP PIN
WVGR9287592OtherMEDICARE GROUP PIN
WVGR9287592OtherMEDICARE GROUP PIN
WVWR0476241Medicare PIN
WVGR9287591OtherMEDICARE GROUP PIN