Provider Demographics
NPI:1740358530
Name:GEORGE H. GRABE DMD PA
Entity type:Organization
Organization Name:GEORGE H. GRABE DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GRABE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-826-5766
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:275 MAIN ST
Mailing Address - City:CHARLESTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03603-0389
Mailing Address - Country:US
Mailing Address - Phone:603-826-5766
Mailing Address - Fax:603-826-5767
Practice Address - Street 1:275 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:NH
Practice Address - Zip Code:03603-0389
Practice Address - Country:US
Practice Address - Phone:603-826-5766
Practice Address - Fax:603-826-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH89191615Medicaid