Healthcare Provider Details

I. General information

NPI: 1447272976
Provider Name (Legal Business Name): RONALD FRANK GRAVITZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15020 SHADY GROVE RD #360
ROCKVILLE MD
20850-3364
US

IV. Provider business mailing address

15020 SHADY GROVE ROAD #360
ROCKVILLE MD
20850-3398
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-2236
  • Fax:
Mailing address:
  • Phone: 301-762-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6317
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: