MEDICARE: DANA GRAVES DDS

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	1223P0300X	Periodontics	A14701	MA
2	1223P0300X	Periodontics	DS0244537L	PA

General Provider Information

NPI Number	:	1750437885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA GRAVES DDS

Provider Business Mailing Address
First Line	:	240 S 40TH ST
Second Line	:	EVANS BUILDING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6030
Country	:	US
Telephone Number	:	215-898-9068
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 S 40TH ST
Second Line	:	EVANS BUILDING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6030
Country	:	US
Telephone Number	:	215-898-9068
Fax Number	:

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	10/18/2016

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Directions to “ DANA GRAVES DDS” Practice Location

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