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General NPI Number Information
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NPI Number | 1710477153
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Entity Type | Organization
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Legal Business Name | DR NATHAN GRAVES AND ASSOCIATES PLLC
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 5920 CAROLINA BEACH RD STE 140
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City | WILMINGTON
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State | NC
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Zip | 28412-3365
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Country | US
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Telephone | 910-742-0664
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Fax |
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Provider Business Mailing Address
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Address Line | 7617 CLARK HILL RD
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City | WILMINGTON
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State | NC
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Zip | 28412-3459
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATHAN GRAVES
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Credential | DMD
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Telephone | 910-742-0664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 10216
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License Number State | NC
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