MEDICARE: ROBERT S KRAVITZ DDS ASSOC

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	DS020797L	PA

General Provider Information

NPI Number	:	1811954654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT S KRAVITZ DDS ASSOC

Provider Business Mailing Address
First Line	:	440 S BROAD ST
Second Line	:	#2508
City	:	PHILA
State	:	PA
Zip	:	19146-4901
Country	:	US
Telephone Number	:	215-985-5889
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 S BROAD ST
Second Line	:	#2508
City	:	PHILA
State	:	PA
Zip	:	19146-4901
Country	:	US
Telephone Number	:	215-985-5889
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	DR. ROBERT SAUL KRAVITZ
Credential	:	DDS
Telephone Number	:	215-985-5889

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	06/16/2014

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