MEDICARE: DR. GREGORY ALAN GRAVE D.D.S.

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	14055	TX

General Provider Information

NPI Number	:	1922002203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY ALAN GRAVE D.D.S.

Provider Business Mailing Address
First Line	:	5800 COIT RD
Second Line	:	SUITE 100
City	:	PLANO
State	:	TX
Zip	:	75023-5942
Country	:	US
Telephone Number	:	972-758-5300
Fax Number	:	469-241-0446

Provider Business Practice Location Address
First Line	:	5800 COIT RD
Second Line	:	SUITE 100
City	:	PLANO
State	:	TX
Zip	:	75023-5942
Country	:	US
Telephone Number	:	972-758-5300
Fax Number	:	469-241-0446

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	12/06/2016

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