Provider Demographics
NPI:1215084249
Name:GRAVES FAMILY DENTISTRY
Entity type:Organization
Organization Name:GRAVES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-754-9248
Mailing Address - Street 1:7017 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-737-3778
Mailing Address - Fax:
Practice Address - Street 1:7503 QUEENS COURT
Practice Address - Street 2:SUITE 3
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-754-9248
Practice Address - Fax:901-737-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty