Individual
DR. DAVID JEROME DEGRAVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2040 CENTRAL CT, GREEN BAY, WI 54311-6276
(920) 468-0504
(920) 468-1316
Mailing address
2040 CENTRAL CT, GREEN BAY, WI 54311-6276
(920) 468-0504
(920) 468-1316
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2833
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33432300
—
WI
Enumeration date
07/27/2006
Last updated
03/12/2019
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