Provider Demographics
NPI:1336152941
Name:KRAVITZ, TOBY P (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOBY
Middle Name:P
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 1:303 US ROUTE 5 S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-9508
Mailing Address - Country:US
Mailing Address - Phone:802-649-2630
Mailing Address - Fax:802-649-1709
Practice Address - Street 1:303 US ROUTE 5 S
Practice Address - Street 2:SUITE 4
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-9508
Practice Address - Country:US
Practice Address - Phone:802-649-2630
Practice Address - Fax:802-649-1709
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT9341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6218OtherBC/BS
VT1002565Medicaid
VT15013OtherDHMC BILLING