MEDICARE: DR. RICHARD L. GRABOWSKY D.D.S.

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	1223P0221X	Pediatric Dentistry	DE60180365	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE60180365	OTHER	WA	DENTAL LICENSE

General Provider Information

NPI Number	:	1841353638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD L. GRABOWSKY D.D.S.

Provider Business Mailing Address
First Line	:	1933 FORT VANCOUVER WAY
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98663-3529
Country	:	US
Telephone Number	:	360-992-2158
Fax Number	:	360-992-2880

Provider Business Practice Location Address
First Line	:	1933 FORT VANCOUVER WAY
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98663-3529
Country	:	US
Telephone Number	:	360-992-2158
Fax Number	:	360-992-2880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	02/28/2018

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