Provider Demographics
NPI:1356472997
Name:GRIBB, LAWRENCE J (DMD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:GRIBB
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 1:123 N HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5411
Mailing Address - Country:US
Mailing Address - Phone:610-323-2253
Mailing Address - Fax:610-326-5870
Practice Address - Street 1:123 N HANOVER ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5411
Practice Address - Country:US
Practice Address - Phone:610-323-2253
Practice Address - Fax:610-326-5870
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024104L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice