1396856472 NPI number — GRABEMAN & STRIEBEL PLL

Table of content: (NPI 1396856472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396856472 NPI number — GRABEMAN & STRIEBEL PLL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRABEMAN & STRIEBEL PLL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STRIEBEL & NICKELL PLL
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396856472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 C SYCAMORE CREEK DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGBORO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45066-2300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-748-8250
Provider Business Mailing Address Fax Number:
937-748-1402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 SYCAMORE CREEK DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SPRINGBORO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45066-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-748-8250
Provider Business Practice Location Address Fax Number:
937-748-1402
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NICKELL
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PARTNER OWNER DENTIST
Authorized Official Telephone Number:
937-748-8250

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1598548 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".