| NPI | 1285828178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JAY GRUBLER Owner 304-233-7400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 2716) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 018722) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2008-06-24 |