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General NPI Number Information
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NPI Number | 1457311235
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Entity Type | Individual
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Provider Name | JOHN R GRAVES DDS
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 49 HARRY KEMP WAY
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City | PROVINCETOWN
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State | MA
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Zip | 02657-1618
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Country | US
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Telephone | 508-487-9395
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Fax | 508-487-3285
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Provider Business Mailing Address
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Address Line | 107 COMMERCIAL ST
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City | MASHPEE
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State | MA
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Zip | 02649-6507
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Country | US
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Telephone | 508-477-7090
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Fax | 508-477-7028
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 15364
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License Number State | MA
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