Provider Demographics
NPI:1912070418
Name:GRABOW, JOHN CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:GRABOW
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 1:3112 UNION AVENUE
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475
Mailing Address - Country:US
Mailing Address - Phone:708-754-8090
Mailing Address - Fax:708-754-8433
Practice Address - Street 1:3112 UNION AVENUE
Practice Address - Street 2:
Practice Address - City:STEGER
Practice Address - State:IL
Practice Address - Zip Code:60475
Practice Address - Country:US
Practice Address - Phone:708-754-8090
Practice Address - Fax:708-754-8433
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.013128122300000X
IL019013128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist