Provider Demographics
NPI:1144323924
Name:HUB DENTAL CLINIC, PC
Entity type:Organization
Organization Name:HUB DENTAL CLINIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:GRASK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-243-6311
Mailing Address - Street 1:655 WALNUT ST
Mailing Address - Street 2:SUITE 134B
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3906
Mailing Address - Country:US
Mailing Address - Phone:515-243-6311
Mailing Address - Fax:515-244-1572
Practice Address - Street 1:655 WALNUT ST
Practice Address - Street 2:SUITE 134B
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3906
Practice Address - Country:US
Practice Address - Phone:515-243-6311
Practice Address - Fax:515-244-1572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA69171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0207498Medicaid
IA001771OtherBLUE DENTAL & BC BS
IA1639355OtherUNITED CONCORDIA
IA24933OtherBC BS FEP