Nick D Gravino, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

18852 Issued in OH

Practice address

560 Dover Center Rd
Bay Village, OH 44140-2361

Phone

(440) 871-7040

Fax

(440) 871-7824

NPI assigned

Dec 19, 2005

Last updated

Jun 21, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371772800000",
    "number": "1700862190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 DOVER CENTER RD",
            "city": "BAY VILLAGE",
            "state": "OH",
            "postal_code": "441402361",
            "telephone_number": "440-871-7040",
            "fax_number": "440-871-7824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 DOVER CENTER RD",
            "city": "BAY VILLAGE",
            "state": "OH",
            "postal_code": "441402361",
            "telephone_number": "440-871-7040",
            "fax_number": "440-871-7824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVINO",
        "first_name": "NICK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2013-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "18852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seth Allen Garcia, LICDC-CS
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• Danielle Marie Gaudino
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• Chelsea Hage, LICDC
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• General Practice Dentistry in Bay Village, OH
• Providers in Bay Village, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.