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General NPI Number Information
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NPI Number | 1124164108
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Entity Type | Organization
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Legal Business Name | DR. STUART L. GRAVES, DDS, MS, PC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5206 LYNGATE CT
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City | BURKE
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State | VA
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Zip | 22015-1631
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Country | US
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Telephone | 703-425-5010
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Fax | 703-323-7287
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Provider Business Mailing Address
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Address Line | 5206 LYNGATE CT
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City | BURKE
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State | VA
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Zip | 22015-1631
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Country | US
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Telephone | 703-425-5010
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Fax | 703-323-7287
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MS. SARA SMITH
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Credential |
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Telephone | 703-425-5010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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