=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104065416
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD H. GRUBER, DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2009
-----------------------------------------------------
Last Update Date | 12/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3612 COFFEE RD A
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93308-5083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-587-7645
-----------------------------------------------------
Fax | 661-587-7656
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3612 COFFEE RD A
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93308-5083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-587-7645
-----------------------------------------------------
Fax | 661-587-7656
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, SOLE PROPRIETOR
-----------------------------------------------------
Name | DR. EDWARD H GRUBER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 661-587-7645
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------