Provider Demographics
NPI:1902913965
Name:GRUBLER, MICHAEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:GRUBLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 NATIONAL ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-233-7400
Mailing Address - Fax:304-233-4110
Practice Address - Street 1:969 NATIONAL ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-233-7400
Practice Address - Fax:304-233-4110
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27161223G0001X
OH0187221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice