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Individual
GRACE TRAVERS
Active
Individual
GRACE TRAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
018001805
IL
122300000X
Dentist
Primary
61514
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61514
DENTIST
CA
Enumeration date
06/17/2011
Last updated
12/03/2021
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