Provider Demographics
NPI:1043202690
Name:GRAU, MICHAEL JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:GRAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3805 EDWARDS RD STE 160
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1948
Mailing Address - Country:US
Mailing Address - Phone:513-321-9627
Mailing Address - Fax:513-321-9629
Practice Address - Street 1:3805 EDWARDS RD STE 160
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1948
Practice Address - Country:US
Practice Address - Phone:513-321-9627
Practice Address - Fax:513-321-9629
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2020-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH16669204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T54074Medicare UPIN
GR0508262Medicare ID - Type Unspecified