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General NPI Number Information
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NPI Number | 1134469869
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Entity Type | Organization
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Legal Business Name | DAVID C. GRUBER, DDS, MS, PC
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Dates
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Enumeration Date | 02/16/2013
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Last Update Date | 02/16/2013
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Provider Practice Location Address
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Address Line | 1100 4 MILE RD NW SUITE C
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City | WALKER
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State | MI
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Zip | 49544-7397
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Country | US
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Telephone | 616-784-5800
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Fax | 616-784-5801
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Provider Business Mailing Address
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Address Line | 1100 4 MILE RD NW SUITE C
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City | WALKER
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State | MI
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Zip | 49544-7397
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Country | US
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Telephone | 616-784-5800
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Fax | 616-784-5801
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID C. GRUBER
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Credential | DDS, MS
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Telephone | 616-784-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2901014839
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License Number State | MI
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