Provider Demographics
NPI:1700994936
Name:HARGRAVE, RALPH D JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:D
Last Name:HARGRAVE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9708 GILESPIE ST
Mailing Address - Street 2:A-101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-7613
Mailing Address - Country:US
Mailing Address - Phone:702-897-1300
Mailing Address - Fax:702-838-0017
Practice Address - Street 1:9708 GILESPIE ST
Practice Address - Street 2:A-101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-7613
Practice Address - Country:US
Practice Address - Phone:702-897-1300
Practice Address - Fax:702-838-0017
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVNV30521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice