Provider Demographics
NPI:1457579302
Name:CRAVATTA, CHAD M (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:M
Last Name:CRAVATTA
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 W SOUTHERN AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4704
Mailing Address - Country:US
Mailing Address - Phone:480-834-6005
Mailing Address - Fax:480-464-8237
Practice Address - Street 1:2220 W SOUTHERN AVE
Practice Address - Street 2:STE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4704
Practice Address - Country:US
Practice Address - Phone:480-834-6005
Practice Address - Fax:480-464-8237
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD70521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics