Healthcare Provider Details

I. General information

NPI: 1922028216
Provider Name (Legal Business Name): RONALD F. GRAVITZ, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
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 RD 360
ROCKVILLE MD
20850-3364
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: DR. RONALD FRANK GRAVITZ
Title or Position: OWNER
Credential: D.M.D.
Phone: 301-762-2236