Provider Demographics
NPI:1285732248
Name:VAN DER GRAAFF, EDITH CORTES (DDS)
Entity type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:CORTES
Last Name:VAN DER GRAAFF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:EDITH
Other - Middle Name:
Other - Last Name:CORTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:510 N COIT RD
Mailing Address - Street 2:SUITE 2048
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:972-470-1700
Mailing Address - Fax:972-470-7755
Practice Address - Street 1:510 N COIT RD
Practice Address - Street 2:STE 2048
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-470-1700
Practice Address - Fax:972-470-1755
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX184071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice