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General NPI Number Information
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NPI Number | 1164986154
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Entity Type | Individual
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Provider Name | TY ALEXANDER GRABOVICH DDS
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Gender | Male
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 790 NW BROAD ST
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City | MURFREESBORO
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State | TN
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Zip | 37129-2766
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Country | US
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Telephone | 615-867-6360
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 WHITESIDE HILL RD
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City | WARTRACE
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State | TN
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Zip | 37183-3029
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Country | US
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Telephone | 931-224-0088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10923
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License Number State | TN
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