Healthcare Provider Details

I. General information

NPI: 1831499433
Provider Name (Legal Business Name): STUART L. GRAVES DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 ROCKVILLE PIKE STE 115
ROCKVILLE MD
20852-7114
US

IV. Provider business mailing address

11200 ROCKVILLE PIKE STE 115
ROCKVILLE MD
20852-7114
US

V. Phone/Fax

Practice location:
  • Phone: 301-881-3840
  • Fax:
Mailing address:
  • Phone: 301-881-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number14694
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14447
License Number StateMD

VIII. Authorized Official

Name: STUART L GRAVES
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 301-881-3840