Provider Demographics
NPI:1396084562
Name:GRATE, WILLIAM SHAUN (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SHAUN
Last Name:GRATE
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 1:3840 BLUFFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-7101
Mailing Address - Country:US
Mailing Address - Phone:770-977-7688
Mailing Address - Fax:
Practice Address - Street 1:670 CANTON RD NE STE C
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7284
Practice Address - Country:US
Practice Address - Phone:770-977-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0103981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice