Provider Demographics
NPI:1578915823
Name:GRAZIANI, GINA (DDS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GRAZIANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 GRAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4676
Mailing Address - Country:US
Mailing Address - Phone:970-928-9500
Mailing Address - Fax:
Practice Address - Street 1:2624 GRAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4676
Practice Address - Country:US
Practice Address - Phone:970-928-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002028101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN.00202810OtherDENTAL LICENSE