Provider Demographics
NPI:1487724076
Name:GRUBNICH, PETE (DDS)
Entity type:Individual
Prefix:DR
First Name:PETE
Middle Name:
Last Name:GRUBNICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5245
Mailing Address - Country:US
Mailing Address - Phone:219-769-6241
Mailing Address - Fax:219-769-6248
Practice Address - Street 1:2464 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5245
Practice Address - Country:US
Practice Address - Phone:219-769-6241
Practice Address - Fax:219-769-6248
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist