Healthcare Provider Details

I. General information

NPI: 1528585007
Provider Name (Legal Business Name): ROBERTA B. GRIBOWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 BROWNS HILL RD
PITTSBURGH PA
15217-2917
US

IV. Provider business mailing address

4516 BROWNS HILL RD
PITTSBURGH PA
15217-2917
US

V. Phone/Fax

Practice location:
  • Phone: 412-697-7997
  • Fax:
Mailing address:
  • Phone: 412-697-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberPHDH000330
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: