Provider Demographics
NPI:1992914345
Name:GRAFE, BRENT R (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:R
Last Name:GRAFE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRENT
Other - Middle Name:R
Other - Last Name:GRAFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2709 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-2411
Mailing Address - Country:US
Mailing Address - Phone:812-476-8000
Mailing Address - Fax:
Practice Address - Street 1:2709 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-2411
Practice Address - Country:US
Practice Address - Phone:812-476-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007991A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics