MEDICARE: PAUL A. GRAF, DDS PA

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1740777150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL A. GRAF, DDS PA

Provider Business Mailing Address
First Line	:	20423 KUYKENDAHL RD STE 200
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3492
Country	:	US
Telephone Number	:	281-580-8848
Fax Number	:	281-826-0084

Provider Business Practice Location Address
First Line	:	20423 KUYKENDAHL RD STE 200
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3492
Country	:	US
Telephone Number	:	281-580-8848
Fax Number	:	281-826-0084

Authorized Official
Title or Position	:	CREDENTIALING AGENT
Name	:	DOROTHY HERNANDEZ
Credential	:
Telephone Number	:	623-258-4520

Provider Enumeration Date	:	04/20/2018
Last Update Date	:	04/20/2018

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