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General NPI Number Information
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NPI Number | 1699941096
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Entity Type | Individual
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Provider Name | RYAN KEITH GRAVER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 115 FARLEY CIR SUITE 201
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City | LEWISBURG
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State | PA
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Zip | 17837-9252
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Country | US
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Telephone | 570-768-4455
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Fax | 866-668-5729
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Provider Business Mailing Address
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Address Line | 115 FARLEY CIR SUITE 201
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City | LEWISBURG
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State | PA
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Zip | 17837-9252
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Country | US
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Telephone | 570-768-4455
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Fax | 866-668-5729
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 22DI02342400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DS036179
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN001209
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License Number State | PA
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