Basic Information
| Provider Information | |||||||||
| NPI: | 1396991733 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRABE | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6099 N 1ST ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937105462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594311400 | ||||||||
| FaxNumber: | 5594311590 | ||||||||
| Practice Location | |||||||||
| Address1: | 6099 N 1ST ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937105462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594311400 | ||||||||
| FaxNumber: | 5594311590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2008 | ||||||||
| LastUpdateDate: | 08/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 57416 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.