Provider Demographics
NPI:1295344836
Name:GRUBBS, ANNA CAROLINE (DDS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:CAROLINE
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 SPRUCE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4333
Mailing Address - Country:US
Mailing Address - Phone:318-267-6307
Mailing Address - Fax:
Practice Address - Street 1:306 CENTER DR
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8625
Practice Address - Country:US
Practice Address - Phone:130-349-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363201223G0001X
CO00205238122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice