MEDICARE: DR. JOHN CHARLES GRABOW 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	122300000X	Dentist	019.013128	IL
2	122300000X	Dentist	019013128	IL

General Provider Information

NPI Number	:	1912070418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CHARLES GRABOW D.D.S.

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

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

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	09/14/2009

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Directions to “ DR. JOHN CHARLES GRABOW D.D.S.” Practice Location

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