Provider Demographics
NPI:1447272976
Name:GRAVITZ, RONALD FRANK (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:FRANK
Last Name:GRAVITZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15020 SHADY GROVE ROAD
Mailing Address - Street 2:#360
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3398
Mailing Address - Country:US
Mailing Address - Phone:301-762-2236
Mailing Address - Fax:
Practice Address - Street 1:15020 SHADY GROVE RD
Practice Address - Street 2:#360
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3364
Practice Address - Country:US
Practice Address - Phone:301-762-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD63171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry