GRAVETTE FAMILY DENTAL – NPI #1417790502
Clinic/Center

GRAVETTE FAMILY DENTAL is an AHC clinic located in GRAVETTE, AR. NPPES has assigned the NPI number 1417790502 to GRAVETTE FAMILY DENTAL on June 17, 2024. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for GRAVETTE FAMILY DENTAL below.

NPI Profile for
GRAVETTE FAMILY DENTAL

NPI Number
1417790502
Enumeration Date

(about 2 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
GRAVETTE FAMILY DENTAL
Primary location
601 1ST AVE SW
GRAVETTE, AR 72736
Phone: (405) 930-4100 Fax:
Mailing address
851 W I 35 FRONTAGE RD STE 350
EDMOND, OK 73034-7461
Phone: (405) 930-4100 Fax:
Organization Subpart
No
Authorized Official
BENJAMIN BOWMAN
CEO
Phone: (405) 326-8004
Updated
Certification Date
Jun 07, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.