Provider Demographics
NPI:1922028216
Name:RONALD F. GRAVITZ, P.A.
Entity Type:Organization
Organization Name:RONALD F. GRAVITZ, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:GRAVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-762-2236
Mailing Address - Street 1:15020 SHADY GROVE RD
Mailing Address - Street 2:360
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3364
Mailing Address - Country:US
Mailing Address - Phone:301-762-2236
Mailing Address - Fax:
Practice Address - Street 1:15020 SHADY GROVE RD
Practice Address - Street 2:360
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3364
Practice Address - Country:US
Practice Address - Phone:301-762-2236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD63171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty