Provider Demographics
NPI:1588964282
Name:DE GRAFF, BENJAMIN PATRICK (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PATRICK
Last Name:DE GRAFF
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 1:7471 SW BARBUR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2809
Mailing Address - Country:US
Mailing Address - Phone:503-246-8447
Mailing Address - Fax:
Practice Address - Street 1:7471 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2809
Practice Address - Country:US
Practice Address - Phone:503-246-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD94771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice