Provider Demographics
NPI:1770651168
Name:GRACIA, ELVIS N (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELVIS
Middle Name:N
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 1:34 CALLE PALM BLVD
Mailing Address - Street 2:GRAND PALM
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9785
Mailing Address - Country:US
Mailing Address - Phone:787-884-5015
Mailing Address - Fax:
Practice Address - Street 1:B38 CALLE ELLIOT VELEZ
Practice Address - Street 2:URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4615
Practice Address - Country:US
Practice Address - Phone:787-884-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice