Basic Information
| Provider Information | |||||||||
| NPI: | 1821017997 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRABE,SCHAPANSKY,MOSS,JULIAN&ASSELIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6099 N 1ST ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937105462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594311400 | ||||||||
| FaxNumber: | 5594311590 | ||||||||
| Practice Location | |||||||||
| Address1: | 6099 N 1ST ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937105462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594311400 | ||||||||
| FaxNumber: | 5594311590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PFEIFFER | ||||||||
| AuthorizedOfficialFirstName: | ROSEMARY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5594311400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.