Basic Information
| Provider Information | |||||||||
| NPI: | 1770691313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRUBISS | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2330 SHAWNEE MISSION PKWY | ||||||||
| Address2: | MEDICAL ADMINSTRATIVE SERVICES OF KU MED. STE 312 | ||||||||
| City: | WESTWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662052005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135889000 | ||||||||
| FaxNumber: | 9135889822 | ||||||||
| Practice Location | |||||||||
| Address1: | 4720 RAINBOW BLVD | ||||||||
| Address2: | KU DENTAL ASSOCIATES, STE. 250 | ||||||||
| City: | WESTWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662051831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135889200 | ||||||||
| FaxNumber: | 9135889203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 09/24/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 6118 | KS | Y | Dental Providers | Dentist |
No ID Information.