Provider Demographics
NPI:1265876742
Name:GRAVES, WILLIAM L (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:GRAVES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3688
Mailing Address - Country:US
Mailing Address - Phone:308-345-1510
Mailing Address - Fax:308-345-2211
Practice Address - Street 1:411 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3688
Practice Address - Country:US
Practice Address - Phone:308-345-1510
Practice Address - Fax:308-345-2211
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist