Provider Demographics
NPI:1346413192
Name:ROBERT E DIGRAZIA, DDS, PA
Entity type:Organization
Organization Name:ROBERT E DIGRAZIA, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:DIGRAZIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-376-7413
Mailing Address - Street 1:900 N LIBERTY ST.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8707
Mailing Address - Country:US
Mailing Address - Phone:208-376-7413
Mailing Address - Fax:208-376-7428
Practice Address - Street 1:900 N LIBERTY ST.
Practice Address - Street 2:SUITE 202
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8707
Practice Address - Country:US
Practice Address - Phone:208-376-7413
Practice Address - Fax:208-376-7428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD1520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty