MEDICARE: DR. LEE GRABER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	019.014054	IL

General Provider Information

NPI Number	:	1205000189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE GRABER D.D.S.

Provider Business Mailing Address
First Line	:	830 W END CT
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1365
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 W END CT
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1365
Country	:	US
Telephone Number	:	847-367-4920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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