Organization
RESTORE DERMATOLOGY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA GRAVES PA-C (SOLE MEMBER)
(539) 281-3101
Entity
Organization
Contact information
Practice address
4700 W URBANA ST STE 100, BROKEN ARROW, OK 74012-5520
(539) 281-3101
Mailing address
4700 W URBANA ST STE 100, BROKEN ARROW, OK 74012-5520
(539) 281-3101
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
12/06/2025
Last updated
12/17/2025
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