Provider Demographics
NPI:1225056849
Name:DIGRAZIA, JOHN CAVITT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CAVITT
Last Name:DIGRAZIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3408
Mailing Address - Country:US
Mailing Address - Phone:775-786-2077
Mailing Address - Fax:775-786-0146
Practice Address - Street 1:1625 LAKESIDE DRIVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3408
Practice Address - Country:US
Practice Address - Phone:775-786-2077
Practice Address - Fax:775-786-0146
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV34731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice