Healthcare Provider Details

I. General information

NPI: 1821022872
Provider Name (Legal Business Name): LOWELL RICHARD GRAVES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 S WADSWORTH BLVD SUITE 300
LAKEWOOD CO
80227-4899
US

IV. Provider business mailing address

PO BOX 23167
SILVERTHORNE CO
80498-3167
US

V. Phone/Fax

Practice location:
  • Phone: 303-988-6110
  • Fax:
Mailing address:
  • Phone: 970-262-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3316
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: