Provider Demographics
NPI:1487722260
Name:GRABE, GEORGE H (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
Last Name:GRABE
Suffix:
Gender:M
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:PO BOX 389
Mailing Address - Street 2:275 MAIN ST.
Mailing Address - City:CHARLESTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03603-0389
Mailing Address - Country:US
Mailing Address - Phone:603-826-5766
Mailing Address - Fax:603-826-5767
Practice Address - Street 1:275 MAIN ST.
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:NH
Practice Address - Zip Code:03603
Practice Address - Country:US
Practice Address - Phone:603-826-5766
Practice Address - Fax:603-826-5767
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH89191615Medicaid
NH1214OtherSTATE LICENSE NUMBER