Provider Demographics
NPI:1003092305
Name:DEGRAZIA, JEANNE ANTOINETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:ANTOINETTE
Last Name:DEGRAZIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-4151
Mailing Address - Country:US
Mailing Address - Phone:219-942-1730
Mailing Address - Fax:219-942-0742
Practice Address - Street 1:250 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-4151
Practice Address - Country:US
Practice Address - Phone:219-942-1730
Practice Address - Fax:219-942-0742
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009463A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200534070Medicaid