MEDICARE: JOHN C GRABOW DDS LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center		IL

General Provider Information

NPI Number	:	1144399684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C GRABOW DDS LTD

Provider Business Mailing Address
First Line	:	3112 UNION AVE
Second Line	:
City	:	STEGER
State	:	IL
Zip	:	60475-1166
Country	:	US
Telephone Number	:	708-754-8090
Fax Number	:	708-754-8433

Provider Business Practice Location Address
First Line	:	3112 UNION AVE
Second Line	:
City	:	STEGER
State	:	IL
Zip	:	60475-1166
Country	:	US
Telephone Number	:	708-754-8090
Fax Number	:	708-754-8433

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN CHARLES GRABOW
Credential	:	DDS
Telephone Number	:	708-754-8090

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/23/2007

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