Healthcare Provider Details

I. General information

NPI: 1174933519
Provider Name (Legal Business Name): ANTHONY GRAGG D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 CREEDMOOR RD STE 120
RALEIGH NC
27613-8000
US

IV. Provider business mailing address

7201 CREEDMOOR RD STE 120
RALEIGH NC
27613-8000
US

V. Phone/Fax

Practice location:
  • Phone: 919-846-6622
  • Fax:
Mailing address:
  • Phone: 919-846-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number016.0107689
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number11682
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: