Provider Demographics
NPI:1750492633
Name:GRAZIANI, STEPHEN (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GRAZIANI
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 1:1213 VIRGINIA ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2941
Mailing Address - Country:US
Mailing Address - Phone:304-343-1216
Mailing Address - Fax:304-343-1292
Practice Address - Street 1:1213 VIRGINIA ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2941
Practice Address - Country:US
Practice Address - Phone:304-343-1216
Practice Address - Fax:304-343-1292
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901343Medicaid
NC9027JOtherBCBS OF NC PROVIDER NUMBE