Healthcare Provider Details

I. General information

NPI: 1417380072
Provider Name (Legal Business Name): BETHANY GRATSON D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2013
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 PERKIOMEN AVE SUITE 101
READING PA
19606-9614
US

IV. Provider business mailing address

30 TENNESSEE AVE
SINKING SPRING PA
19608-9471
US

V. Phone/Fax

Practice location:
  • Phone: 484-334-2310
  • Fax: 484-334-2311
Mailing address:
  • Phone: 724-601-6951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS038715
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: