Provider Demographics
NPI:1871776088
Name:JOHN L. GRAVITTE, D.D.S., P.A.
Entity type:Organization
Organization Name:JOHN L. GRAVITTE, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAVITTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-719-2273
Mailing Address - Street 1:202 RAWLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3530
Mailing Address - Country:US
Mailing Address - Phone:336-719-2273
Mailing Address - Fax:336-719-2265
Practice Address - Street 1:202 RAWLEY AVE
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3530
Practice Address - Country:US
Practice Address - Phone:336-719-2273
Practice Address - Fax:336-719-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty