Provider Demographics
NPI:1538360920
Name:GRUBOWSKI, SUZANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:GRUBOWSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 STATE HIGHWAY #36
Mailing Address - Street 2:
Mailing Address - City:BELFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07718
Mailing Address - Country:US
Mailing Address - Phone:732-787-4820
Mailing Address - Fax:
Practice Address - Street 1:559 STATE HIGHWAY #36
Practice Address - Street 2:
Practice Address - City:BELFORD
Practice Address - State:NJ
Practice Address - Zip Code:07718
Practice Address - Country:US
Practice Address - Phone:732-787-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI018941001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice