Provider Demographics
NPI:1003275421
Name:GRACZA & GRACZA INC
Entity Type:Organization
Organization Name:GRACZA & GRACZA INC
Other - Org Name:ROSEAU DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-450-2944
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-0280
Mailing Address - Country:US
Mailing Address - Phone:218-450-2944
Mailing Address - Fax:218-450-2945
Practice Address - Street 1:903 3RD ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751-1217
Practice Address - Country:US
Practice Address - Phone:218-450-2944
Practice Address - Fax:218-450-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND102361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty