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General NPI Number Information
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NPI Number | 1851854236
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Entity Type | Organization
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Legal Business Name | PATRICK R. GRUBE DDS PC
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 1245 CEDAR RD STE L
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City | CHESAPEAKE
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State | VA
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Zip | 23322-7141
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Country | US
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Telephone | 757-382-9336
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Fax |
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Provider Business Mailing Address
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Address Line | 211 66TH ST
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-2040
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Country | US
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Telephone | 757-642-0549
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PATRICK GRUBE
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Credential | DDS
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Telephone | 757-642-0549
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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 |
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License Number State |
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