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General NPI Number Information
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NPI Number | 1386714210
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Entity Type | Individual
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Provider Name | ALBERT FITZ GRUBER II DMD
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | UNIVERSITY OF TENNESSEE COLLEGE OF DENTISTRY 875 UNION AVE
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City | MEMPHIS
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State | IL
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Zip | 38163
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Country | US
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Telephone | 901-448-6271
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Fax | 708-339-5567
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Provider Business Mailing Address
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Address Line | 1697 LISSON LANE
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City | COLLIERVILLE
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State | TN
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Zip | 38017
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Country | US
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Telephone | 708-212-7995
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Fax | 708-339-5567
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-019995
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12009737A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6830
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11979
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License Number State | TN
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