MEDICARE: DR. NEAL D. KRAVITZ DMD, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	13716	MD

General Provider Information

NPI Number	:	1477759298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEAL D. KRAVITZ DMD, MS

Provider Business Mailing Address
First Line	:	25055 RIDING PLAZA
Second Line	:	SUITE 110
City	:	CHANTILLY
State	:	VA
Zip	:	20152-5918
Country	:	US
Telephone Number	:	703-722-2900
Fax Number	:	703-722-2903

Provider Business Practice Location Address
First Line	:	25055 RIDING PLAZA
Second Line	:	SUITE 110
City	:	CHANTILLY
State	:	VA
Zip	:	20152-5918
Country	:	US
Telephone Number	:	703-722-2900
Fax Number	:	703-722-2903

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	08/20/2020

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