Provider Demographics
NPI:1972917128
Name:KRAVITZ, ROBERT SAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SAUL
Last Name:KRAVITZ
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 1:9945 NW UPTON CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-8163
Mailing Address - Country:US
Mailing Address - Phone:503-504-6064
Mailing Address - Fax:
Practice Address - Street 1:9945 NW UPTON CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-8163
Practice Address - Country:US
Practice Address - Phone:503-504-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020797L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist