Healthcare Provider Details

I. General information

NPI: 1760216816
Provider Name (Legal Business Name): CHAD M CRAVATTA DMD MS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 W SOUTHERN AVE STE 101
MESA AZ
85202-4706
US

IV. Provider business mailing address

2220 W SOUTHERN AVE STE 101
MESA AZ
85202-4706
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-6005
  • Fax: 480-464-8237
Mailing address:
  • Phone: 480-834-6005
  • Fax: 480-464-8237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAD M CRAVATTA
Title or Position: OWNER
Credential: DMD
Phone: 480-834-6005