Provider Demographics
NPI:1154583987
Name:GRAF, JOHN CARL III (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARL
Last Name:GRAF
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:GRAF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:307 GABRIEL ST
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63730-0039
Mailing Address - Country:US
Mailing Address - Phone:573-722-3044
Mailing Address - Fax:
Practice Address - Street 1:307 GABRIEL ST
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:MO
Practice Address - Zip Code:63730-0039
Practice Address - Country:US
Practice Address - Phone:573-722-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86101223G0001X
MO20110188031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice