Provider Demographics
NPI:1386129955
Name:GRAVETTE DENTAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:GRAVETTE DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-736-2800
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:GRAVETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736-0125
Mailing Address - Country:US
Mailing Address - Phone:479-736-2800
Mailing Address - Fax:
Practice Address - Street 1:1102 JACKSON ST SW
Practice Address - Street 2:
Practice Address - City:GRAVETTE
Practice Address - State:AR
Practice Address - Zip Code:72736-9121
Practice Address - Country:US
Practice Address - Phone:479-736-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental