Provider Demographics
NPI:1417380072
Name:GRATSON, BETHANY (DMD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:GRATSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9471
Mailing Address - Country:US
Mailing Address - Phone:724-601-6951
Mailing Address - Fax:
Practice Address - Street 1:5001 PERKIOMEN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9614
Practice Address - Country:US
Practice Address - Phone:484-334-2310
Practice Address - Fax:484-334-2311
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0387151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry