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General NPI Number Information
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NPI Number | 1720482607
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Entity Type | Organization
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Legal Business Name | JEANNE GRAVES
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 2099 W. US HWY 50 SUITE #180
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City | PUEBLO
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State | CO
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Zip | 81008-1673
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Country | US
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Telephone | 719-542-2489
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Fax |
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Provider Business Mailing Address
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Address Line | 2099 W. US HWY 50 SUITE #180
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City | PUEBLO
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State | CO
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Zip | 81008-1673
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Country | US
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Telephone | 719-542-2489
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEANNE GRAVES
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Credential | R.D.H.
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Telephone | 719-542-2489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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