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General NPI Number Information
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NPI Number | 1508677493
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Entity Type | Organization
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Legal Business Name | GRIBB OMFS LLC
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Dates
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Enumeration Date | 01/18/2025
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Last Update Date | 01/18/2025
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Provider Practice Location Address
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Address Line | 501 W 14TH ST
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City | WILMINGTON
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State | DE
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Zip | 19801-1013
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Country | US
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Telephone | 610-310-5696
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Fax |
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Provider Business Mailing Address
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Address Line | 9 HILLCREST DR
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City | BOYERTOWN
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State | PA
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Zip | 19512-9202
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Country | US
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Telephone | 610-310-5696
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Fax |
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Authorized Official
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Title or Position | OWNER/SURGEON
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Name | JACOB PAULY GRIBB
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Credential | DMD
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Telephone | 610-310-5696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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