Individual
DR. JACK GRUBER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
54 OLD POND RD, GREAT NECK, NY 11023-1031
(516) 466-3605
Mailing address
54 OLD POND RD, GREAT NECK, NY 11023-1031
(516) 466-3605
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
028946
NY
Other
Enumeration date
11/17/2006
Last updated
07/08/2007
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