Provider Demographics
NPI:1700862190
Name:GRAVINO, NICK D (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:D
Last Name:GRAVINO
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 1:560 DOVER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2361
Mailing Address - Country:US
Mailing Address - Phone:440-871-7040
Mailing Address - Fax:440-871-7824
Practice Address - Street 1:560 DOVER CENTER RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2361
Practice Address - Country:US
Practice Address - Phone:440-871-7040
Practice Address - Fax:440-871-7824
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH188521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice