MEDICARE: JACOB A. GRACA, DDS PLLC

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

General Provider Information

NPI Number	:	1932992336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOB A. GRACA, DDS PLLC

Provider Business Mailing Address
First Line	:	2303 BEEBE RD
Second Line	:
City	:	WILSON
State	:	NY
Zip	:	14172-9648
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 BEEBE RD
Second Line	:
City	:	WILSON
State	:	NY
Zip	:	14172-9648
Country	:	US
Telephone Number	:	716-320-0588
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACOB ANTONIO GRACA
Credential	:	DDS
Telephone Number	:	716-320-0588

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	05/05/2026

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