MEDICARE: GRABER FAMILY DENTISTRY

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	261QD0000X	Dental Clinic/Center	12011289A	IN

General Provider Information

NPI Number	:	1477786283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRABER FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	PO BOX 604
Second Line	:
City	:	PRINCETON
State	:	IN
Zip	:	47670-0604
Country	:	US
Telephone Number	:	812-386-6150
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S MAIN ST
Second Line	:
City	:	PRINCETON
State	:	IN
Zip	:	47670-2653
Country	:	US
Telephone Number	:	812-386-6150
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DEREK O GRABER
Credential	:	DDS
Telephone Number	:	18123866150

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	08/26/2009

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Directions to “GRABER FAMILY DENTISTRY ” Practice Location

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