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General NPI Number Information
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NPI Number | 1891080339
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Entity Type | Individual
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Provider Name | JASON RICHARD GRAVES DMD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 100 PAVILION WAY STE G
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-4539
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Country | US
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Telephone | 910-684-3687
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Fax | 910-401-1918
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Provider Business Mailing Address
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Address Line | 100 PAVILION WAY STE G
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-4539
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Country | US
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Telephone | 910-684-3687
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Fax | 910-401-1918
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9127
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License Number State | NC
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