# DE GRAFFENRIED DENTAL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** J de Graffenried Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962092049
- **Authorized official:** MS. JENNIFER SAMPLES (HUMAN RESOURCES)
- **Authorized official phone:** (903) 984-0614

## Contact information

- **Practice address:** 238 LAWRENCE ST, KILGORE, TX 75662-2610
- **Practice address phone:** (903) 984-0614
- **Practice address fax:** (903) 984-3834
- **Mailing address:** 238 LAWRENCE ST, KILGORE, TX 75662-2610
- **Mailing address phone:** (903) 984-0614
- **Mailing address fax:** (903) 984-3834

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/22/2021
- **Last updated:** 01/22/2021