Ronald Alan Grace, DDS
Individual provider Active NPI Dentist · Chelyan, WV
NPI 1801931019 · NPPES record last updated Jan 2, 2015
Key facts
- NPI
- 1801931019
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2678 (WV)
- Practice address
- 15081 Maccorkle Ave
Chelyan, WV 25035-0040 - Phone
- (304) 595-3551
- Fax
- (304) 595-6822
- NPI assigned
- Feb 21, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2678 | WV | MD | Internal Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2678 | WV | Yes |
Addresses
Primary practice location
15081 Maccorkle Ave
Chelyan, WV 25035-0040
Mailing address
15081 Maccorkle Ave
Box 40
Chelyan, WV 25035-0040
Phone (304) 595-3551
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000119839 | Other | BLUE CROSS BS | |
| 0137007000 | Medicaid | WV | |
| 119839 | Other | UNITED CONCORDIA |
Other names
- Dr. Ronald Ronald Grace
Other providers in Chelyan, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.