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General NPI Number Information
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NPI Number | 1457781379
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Entity Type | Organization
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Legal Business Name | SHELDON M.GRAVES PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 4137 KIRBY PKWY SUITE 4
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City | MEMPHIS
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State | TN
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Zip | 38115-6532
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Country | US
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Telephone | 901-433-0701
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Fax | 901-433-0703
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Provider Business Mailing Address
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Address Line | 4137 KIRBY PKWY SUITE 4
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City | MEMPHIS
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State | TN
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Zip | 38115-6532
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Country | US
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Telephone | 901-433-0701
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Fax | 901-433-0703
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHELDON M. GRAVES
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Credential | D.D.S.
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Telephone | 901-433-0701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS0000008876
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS0000004417
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License Number State | TN
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