Provider Demographics
NPI:1902940653
Name:GRABOWSKI, KENNETH WILLIAM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WILLIAM
Last Name:GRABOWSKI
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:7864 MOORS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4424
Mailing Address - Country:US
Mailing Address - Phone:269-323-0212
Mailing Address - Fax:269-323-8380
Practice Address - Street 1:7864 MOORS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4424
Practice Address - Country:US
Practice Address - Phone:269-323-0212
Practice Address - Fax:269-323-8380
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI0124921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics