Healthcare Provider Details

I. General information

NPI: 1033304530
Provider Name (Legal Business Name): MICHAEL GRABOW DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2007
Last Update Date: 09/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W RAY RD SUITE 7
CHANDLER AZ
85226-5940
US

IV. Provider business mailing address

3800 W RAY RD SUITE 7
CHANDLER AZ
85226-5940
US

V. Phone/Fax

Practice location:
  • Phone: 480-857-4047
  • Fax: 480-857-4049
Mailing address:
  • Phone: 480-857-4047
  • Fax: 480-857-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4842
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: