Nicholas Banks Grubor, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

28383 Issued in FL

Practice address

1805 Blanding Blvd Ste 101
Middleburg, FL 32068-3839

Phone

(904) 214-3476

NPI assigned

Jul 24, 2023

Last updated

Jul 24, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rusha George Awad, LLC

  dba West Nassau Dental Care

  • Dental Clinic/Center
  • Callahan, FL
  • NPI 1922872019
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1417637596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 LAKESHORE DR N",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320037707",
            "telephone_number": "904-460-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 BLANDING BLVD STE 101",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320683839",
            "telephone_number": "904-214-3476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450100 State Road 200",
            "address_purpose": "LOCATION",
            "city": "Callahan",
            "state": "FL",
            "postal_code": "320115064",
            "country_code": "US",
            "telephone_number": "904-879-6998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRUBOR",
        "first_name": "NICHOLAS",
        "middle_name": "BANKS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-24",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "28383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael A Greene, D.O.
• Tracee Greenwade, CBHCMS
• Roger Gref, CAP
• Jenny Jean Gregory, ARNP
• Madeline Jane Grooms, PA-C
• H2 Rehabilitation Services of Florida LLC (H2 Health)
• Diann B. Hall, RN
• Mary Grace Hall, RN
• Amanda Lei Hammock, MASSAGE THERAPIST
• Michael Hanna, M.D

• General Practice Dentistry in Middleburg, FL
• Providers in Middleburg, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.