Provider Demographics
NPI:1194166959
Name:GRAZIANO, CAITLIN DEITZ (DDS)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:DEITZ
Last Name:GRAZIANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:DEITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:600 MCCLELLAN ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1009
Mailing Address - Country:US
Mailing Address - Phone:518-382-2270
Mailing Address - Fax:518-347-5124
Practice Address - Street 1:600 MCCLELLAN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1009
Practice Address - Country:US
Practice Address - Phone:518-382-2270
Practice Address - Fax:518-347-5124
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03968669Medicaid