Healthcare Provider Details

I. General information

NPI: 1124126131
Provider Name (Legal Business Name): R P MCGRAW DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 NORTHLAND DR
CAMERON MO
64429-1344
US

IV. Provider business mailing address

4731 COCHISE SUITE 210
INDEPENDENCE MO
64055-6975
US

V. Phone/Fax

Practice location:
  • Phone: 816-632-6700
  • Fax: 816-632-6702
Mailing address:
  • Phone: 816-632-6700
  • Fax: 816-632-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2000695
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateMO

VIII. Authorized Official

Name: ROBERT PAUL MCGRAW JR.
Title or Position: LLC OWNER/MANAGER
Credential: DDS
Phone: 816-225-8200