Healthcare Provider Details

I. General information

NPI: 1487722260
Provider Name (Legal Business Name): GEORGE H. GRABE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MAIN ST.
CHARLESTOWN NH
03603
US

IV. Provider business mailing address

PO BOX 389 275 MAIN ST.
CHARLESTOWN NH
03603-0389
US

V. Phone/Fax

Practice location:
  • Phone: 603-826-5766
  • Fax: 603-826-5767
Mailing address:
  • Phone: 603-826-5766
  • Fax: 603-826-5767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1214
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: