Healthcare Provider Details

I. General information

NPI: 1346427416
Provider Name (Legal Business Name): CHARLES E GRAPER MD DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 NW 57TH ST
GAINESVILLE FL
32605-6415
US

IV. Provider business mailing address

832 NW 57TH ST
GAINESVILLE FL
32605-6415
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-6661
  • Fax: 352-331-6336
Mailing address:
  • Phone: 352-331-6661
  • Fax: 352-331-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberME0045100
License Number StateFL

VIII. Authorized Official

Name: BEVERLY GRAPER
Title or Position: PRESIDENT
Credential:
Phone: 352-331-6661