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General NPI Number Information
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NPI Number | 1831870724
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Entity Type | Individual
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Provider Name | DARYL GRAVES
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Gender | Male
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 5997 S GOLDENROD RD
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City | ORLANDO
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State | FL
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Zip | 32822
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Country | US
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Telephone | 407-241-8957
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 CHESTNUT ST
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City | PORTSMOUTH
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State | VA
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Zip | 23704-4713
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Country | US
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Telephone | 508-402-3186
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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 | 0401417195
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License Number State | VA
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