Healthcare Provider Details

I. General information

NPI: 1912070418
Provider Name (Legal Business Name): JOHN CHARLES GRABOW D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 UNION AVENUE
STEGER IL
60475
US

IV. Provider business mailing address

3112 UNION AVENUE
STEGER IL
60475
US

V. Phone/Fax

Practice location:
  • Phone: 708-754-8090
  • Fax: 708-754-8433
Mailing address:
  • Phone: 708-754-8090
  • Fax: 708-754-8433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.013128
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019013128
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: