Provider Demographics
NPI:1174547301
Name:GRAVIL, RONALD AARON (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:AARON
Last Name:GRAVIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 PEARTREE LN
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-4460
Mailing Address - Country:US
Mailing Address - Phone:270-885-4344
Mailing Address - Fax:
Practice Address - Street 1:1870 PEARTREE LN
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4460
Practice Address - Country:US
Practice Address - Phone:270-885-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8082122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60003233Medicaid