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General NPI Number Information
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NPI Number | 1548611536
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Entity Type | Individual
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Provider Name | STEVEN VAN DE GRAAFF
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Gender | Male
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Dates
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Enumeration Date | 06/30/2016
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Last Update Date | 06/30/2016
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Provider Practice Location Address
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Address Line | 99 CRESTVIEW DR
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-4701
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Country | US
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Telephone | 402-249-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 748 LOCKS HILL CT
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City | MARTINEZ
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State | GA
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Zip | 30907-4978
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Country | US
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Telephone | 402-249-0002
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DGD 8744
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License Number State | SC
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