Provider Demographics
NPI:1831399351
Name:EDWARD H. GRUBER D.D.S.
Entity type:Organization
Organization Name:EDWARD H. GRUBER D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-827-9183
Mailing Address - Street 1:1491 WHITE LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-4677
Mailing Address - Country:US
Mailing Address - Phone:661-827-9183
Mailing Address - Fax:661-827-9185
Practice Address - Street 1:1491 WHITE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-4677
Practice Address - Country:US
Practice Address - Phone:661-827-9183
Practice Address - Fax:661-827-9185
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWARD H. GRUBER D.D.S
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33020261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9139301Medicaid