Healthcare Provider Details

I. General information

NPI: 1558436485
Provider Name (Legal Business Name): MIDFIELD DENTAL CENTER ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E BROOKWOOD ROAD
MIDFIELD AL
35228
US

IV. Provider business mailing address

114 E BROOKWOOD ROAD
MIDFIELD AL
35228
US

V. Phone/Fax

Practice location:
  • Phone: 205-923-6828
  • Fax:
Mailing address:
  • Phone: 205-923-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3419
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2563
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3460
License Number StateAL

VIII. Authorized Official

Name: DR. WILLIAM JEFFERSON GRAVES
Title or Position: PRESIDENT
Credential: DMD
Phone: 205-923-6828