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General NPI Number Information
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NPI Number | 1972704799
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Entity Type | Individual
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Provider Name | DR. LESTER ROSE GRAVES III
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Gender | Male
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7503 QUEENS COURT SUITE 3
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City | GERMANTOWN
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State | TN
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Zip | 38138
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Country | US
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Telephone | 901-754-9248
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Fax | 901-753-5667
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Provider Business Mailing Address
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Address Line | 7017 WESTERN AVE
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City | GERMANTOWN
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State | TN
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Zip | 38138
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Country | US
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Telephone | 901-737-3778
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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 | DS004674
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License Number State | TN
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