Healthcare Provider Details

I. General information

NPI: 1740184332
Provider Name (Legal Business Name): DENNISE C MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GRAF DENTAL CLINIC
APO AE
09114
US

IV. Provider business mailing address

PSC 415 BOX 6859
APO AE
09114-0069
US

V. Phone/Fax

Practice location:
  • Phone: 152-298-5093
  • Fax:
Mailing address:
  • Phone: 152-298-5093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number22355
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1229772
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: