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General NPI Number Information
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NPI Number | 1114002375
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Entity Type | Organization
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Legal Business Name | P RONALD GRAZIANI DDS LTD
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 315 FIRST ST
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City | FAIRMONT
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State | WV
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Zip | 26554-2802
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Country | US
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Telephone | 304-366-3378
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Fax | 304-366-5978
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Provider Business Mailing Address
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Address Line | 315 FIRST ST
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City | FAIRMONT
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State | WV
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Zip | 26554-2802
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Country | US
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Telephone | 304-366-7771
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Fax | 304-366-5978
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PAUL RONALD GRAZIANI
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Credential | DDS
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Telephone | 304-366-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2070
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License Number State | WV
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