Provider Demographics
NPI:1306278452
Name:GRAVES, JAMES JASON (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JASON
Last Name:GRAVES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SHORT CUT RD.
Mailing Address - Street 2:INCHELIUM COMMUNITY HEALTH CENTER
Mailing Address - City:INCHELIUM
Mailing Address - State:WA
Mailing Address - Zip Code:99138-0290
Mailing Address - Country:US
Mailing Address - Phone:509-722-7013
Mailing Address - Fax:
Practice Address - Street 1:39 SHORT CUT RD.
Practice Address - Street 2:INCHELIUM COMMUNITY HEALTH CENTER
Practice Address - City:INCHELIUM
Practice Address - State:WA
Practice Address - Zip Code:99138-0290
Practice Address - Country:US
Practice Address - Phone:509-722-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60398206122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist