Provider Demographics
NPI:1346392172
Name:GRACIA, ALVARO E (DMD)
Entity Type:Individual
Prefix:MR
First Name:ALVARO
Middle Name:E
Last Name:GRACIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W MAIN ST
Mailing Address - Street 2:P O BOX 470
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2713
Mailing Address - Country:US
Mailing Address - Phone:508-285-8301
Mailing Address - Fax:508-285-6014
Practice Address - Street 1:100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2713
Practice Address - Country:US
Practice Address - Phone:508-285-8301
Practice Address - Fax:508-285-6014
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187401223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics