Provider Demographics
NPI:1124126131
Name:R P MCGRAW DDS LLC
Entity type:Organization
Organization Name:R P MCGRAW DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LLC OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-225-8200
Mailing Address - Street 1:4731 COCHISE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6975
Mailing Address - Country:US
Mailing Address - Phone:816-632-6700
Mailing Address - Fax:816-632-6702
Practice Address - Street 1:417 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-1344
Practice Address - Country:US
Practice Address - Phone:816-632-6700
Practice Address - Fax:816-632-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1223G0001X
MO2000695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31565026OtherBCBS OF MO