Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 016.0107689 | VT |
Y | 1223P0700X | Prosthodontist | 11682 | NC |
NPI | 1174933519 |
---|---|
Provider Name | Dr. Anthony Gragg |
First Address | Raleigh, NC 27613-8000 |
Second Address | Raleigh, NC 27613-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2014 |
Last Update Date | 08/07/2020 |