Healthcare Provider Details

I. General information

NPI: 1538300355
Provider Name (Legal Business Name): THOMAS D GRUBBS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 ST JAMES CIR
BEAUFORT SC
29907-1971
US

IV. Provider business mailing address

229 DENTAL SCIENCE BLDG S
IOWA CITY IA
52242-1001
US

V. Phone/Fax

Practice location:
  • Phone: 913-302-1482
  • Fax: 913-302-1482
Mailing address:
  • Phone: 319-335-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60670
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number30425
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: