Individual
DR. ROGER EDMUND GRAVEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
201 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1507
(336) 718-1869
(336) 718-1835
Mailing address
1601 YARMOUTH LN, CLEMMONS, NC 27012-8001
(336) 945-9004
(336) 718-1835
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4436
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4436
DENTAL LICENCE
NC
Enumeration date
07/14/2006
Last updated
07/08/2007
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