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General NPI Number Information
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NPI Number | 1396117131
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Entity Type | Organization
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Legal Business Name | GRAF FAMILY DENTISTRY, PSC
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 4001 KRESGE WAY SUITE 120
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City | LOUISVILLE
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State | KY
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Zip | 40207-4640
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Country | US
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Telephone | 502-895-0905
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 HILLVALE RD
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City | LOUISVILLE
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State | KY
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Zip | 40241-2811
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Country | US
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Telephone | 502-640-6932
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN CARL GRAF III
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Credential | DMD
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Telephone | 502-640-6932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8610
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License Number State | KY
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