Organization
WALTER A GRAGE DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER A GRAGE DDS (PRESIDENT)
(404) 289-6454
Entity
Organization
Contact information
Practice address
4324 COVINGTON HWY, DECATUR, GA 30035
(404) 289-6454
(404) 289-2570
Mailing address
4324 COVINGTON HWY, DECATUR, GA 30035
(404) 289-6454
(404) 289-2570
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6216
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00046175B
—
GA
Enumeration date
10/05/2006
Last updated
08/22/2020
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