Provider Demographics
NPI:1770691313
Name:GRUBISS, FREDERICK C (DDS)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:C
Last Name:GRUBISS
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 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:MEDICAL ADMINSTRATIVE SERVICES OF KU MED. STE 312
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-9000
Mailing Address - Fax:913-588-9822
Practice Address - Street 1:4720 RAINBOW BLVD
Practice Address - Street 2:KU DENTAL ASSOCIATES, STE. 250
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-1831
Practice Address - Country:US
Practice Address - Phone:913-588-9200
Practice Address - Fax:913-588-9203
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V10015Medicare UPIN
KSK40E747Medicare PIN