Provider Demographics
NPI:1992099550
Name:GRAFF, BRAD WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:WILLIAM
Last Name: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 1:3107 STIRLING RD
Mailing Address - Street 2:108
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6565
Mailing Address - Country:US
Mailing Address - Phone:954-963-3706
Mailing Address - Fax:954-963-1223
Practice Address - Street 1:3107 STIRLING RD
Practice Address - Street 2:108
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6565
Practice Address - Country:US
Practice Address - Phone:954-963-3706
Practice Address - Fax:954-963-1223
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11270122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist