Provider Demographics
NPI:1295953586
Name:BAX, GRACI MARRA (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACI
Middle Name:MARRA
Last Name:BAX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 FOREST EDGE DR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1246
Mailing Address - Country:US
Mailing Address - Phone:716-531-2389
Mailing Address - Fax:
Practice Address - Street 1:364 FOREST EDGE DR
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1246
Practice Address - Country:US
Practice Address - Phone:716-531-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist