Healthcare Provider Details

I. General information

NPI: 1245349141
Provider Name (Legal Business Name): JAMES A. GRABOW, DDS, MS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MORNING STAR DR STE A
SONORA CA
95370-9249
US

IV. Provider business mailing address

800 MORNING STAR DR STE A
SONORA CA
95370-9249
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-5788
  • Fax: 209-532-5834
Mailing address:
  • Phone: 209-532-5788
  • Fax: 209-532-5834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number34847
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES A GRABOW
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 209-532-5788