Provider Demographics
NPI:1285155606
Name:GRAUL, STEPHEN TYLER (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:TYLER
Last Name:GRAUL
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 1:3543 TATES CREEK RD APT 3
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2639
Mailing Address - Country:US
Mailing Address - Phone:859-948-8144
Mailing Address - Fax:
Practice Address - Street 1:431 REDDING RD # 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-2534
Practice Address - Country:US
Practice Address - Phone:859-266-2149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY99171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice