Healthcare Provider Details

I. General information

NPI: 1124164108
Provider Name (Legal Business Name): DR. STUART L. GRAVES, DDS, MS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5206 LYNGATE CT
BURKE VA
22015-1631
US

IV. Provider business mailing address

5206 LYNGATE CT
BURKE VA
22015-1631
US

V. Phone/Fax

Practice location:
  • Phone: 703-425-5010
  • Fax: 703-323-7287
Mailing address:
  • Phone: 703-425-5010
  • Fax: 703-323-7287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SARA SMITH
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 703-425-5010