MEDICARE: JEFFERY ROBERT GRAVES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30918	CA
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	30918	CA

General Provider Information

NPI Number	:	1184601791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY ROBERT GRAVES DDS

Provider Business Mailing Address
First Line	:	19 ROTARY WAY
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-8475
Country	:	US
Telephone Number	:	707-642-0433
Fax Number	:	707-642-5032

Provider Business Practice Location Address
First Line	:	19 ROTARY WAY
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-8475
Country	:	US
Telephone Number	:	707-642-0433
Fax Number	:	707-642-5032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	08/22/2025

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