Provider Demographics
NPI:1114002375
Name:P RONALD GRAZIANI DDS LTD
Entity Type:Organization
Organization Name:P RONALD GRAZIANI DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:GRAZIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-366-7771
Mailing Address - Street 1:315 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2802
Mailing Address - Country:US
Mailing Address - Phone:304-366-7771
Mailing Address - Fax:304-366-5978
Practice Address - Street 1:315 FIRST ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2802
Practice Address - Country:US
Practice Address - Phone:304-366-3378
Practice Address - Fax:304-366-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0135200000Medicaid
500292OtherUNITED CONCORDIA