1568595312 NPI number — GEORGE J GROBINS DDS PS

Table of content: (NPI 1568595312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568595312 NPI number — GEORGE J GROBINS DDS PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE J GROBINS DDS PS
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:
Provider Other Organization Name Type Code:
6
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:
1568595312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7810 WEST 27TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIVERSITY PLACE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98466-4111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-564-2722
Provider Business Mailing Address Fax Number:
253-564-0321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7810 WEST 27TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-564-2722
Provider Business Practice Location Address Fax Number:
253-564-0321
Provider Enumeration Date:
03/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GROBINS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
JURIS
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
253-564-2722

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  003810 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0085205 . This is a "DEPT OF LABORER&INDUST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: L0791 . This is a "CITY BUSINESS LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 587870 . This is a "UNITED CONCORDIA INS CO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 600363819 . This is a "DEPT OF REVENUE" identifier . This identifiers is of the category "OTHER".