Provider Demographics
NPI:1588705925
Name:GAVRIC, GRACE SUSAN (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:SUSAN
Last Name:GAVRIC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1100 CIRCLE 75 PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:770-980-0558
Mailing Address - Fax:770-980-1092
Practice Address - Street 1:1100 CIRCLE 75 PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339
Practice Address - Country:US
Practice Address - Phone:770-980-0558
Practice Address - Fax:770-980-1092
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist