MEDICARE: DR. JORGE ALBERTO GRAZIANI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1776	PR

General Provider Information

NPI Number	:	1396715710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE ALBERTO GRAZIANI DMD

Provider Business Mailing Address
First Line	:	828 WOODSTREAM WAY
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-9567
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1647 TAUSSIG BLVD
Second Line	:	NAVAL DENTAL CENTER, MID-ATLANTIC
City	:	NORFOLK
State	:	VA
Zip	:	23511-2896
Country	:	US
Telephone Number	:	757-314-6561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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