Provider Demographics
NPI:1922002203
Name:GRAVE, GREGORY ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:GRAVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5800 COIT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5942
Mailing Address - Country:US
Mailing Address - Phone:972-758-5300
Mailing Address - Fax:469-241-0446
Practice Address - Street 1:5800 COIT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5942
Practice Address - Country:US
Practice Address - Phone:972-758-5300
Practice Address - Fax:469-241-0446
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX140551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice