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NPI Code Detail

MEDICARE: DR. ELIZABETH GRACA DMD, PHD

MEDICARE: DR. ELIZABETH GRACA DMD, PHD
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
1122300000XDentist019033636IL

General Provider Information

NPI Number : 1518696053
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH GRACA DMD, PHD
Provider Business Mailing Address
First Line : 1400 S MICHIGAN AVE APT 1206
Second Line :
City : CHICAGO
State : IL
Zip : 60605-3721
Country : US
Telephone Number : 305-989-3589
Fax Number :
Provider Business Practice Location Address
First Line : 6857 S PULASKI RD
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4151
Country : US
Telephone Number : 305-989-3589
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2022
Last Update Date : 06/09/2022

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