Healthcare Provider Details

I. General information

NPI: 1548037161
Provider Name (Legal Business Name): TRENT E. GRAVES, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 OLYMPIC BLVD
WALNUT CREEK CA
94595-1623
US

IV. Provider business mailing address

2231 OLYMPIC BLVD
WALNUT CREEK CA
94595-1623
US

V. Phone/Fax

Practice location:
  • Phone: 925-937-5020
  • Fax:
Mailing address:
  • Phone: 925-937-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRENT GRAVES
Title or Position: CEO
Credential: DDS
Phone: 925-212-4301