Individual
DR. CARMEN VILLASANTE GRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S, M.S
Contact information
Practice address
850 S WABASH AVE STE 240, CHICAGO, IL 60605-3643
(312) 356-4700
Mailing address
850 S WABASH AVE STE 240, CHICAGO, IL 60605-3643
(312) 356-4700
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
019.031010
IL
1223P0300X
Periodontics
Primary
021.002792
IL
1223P0300X
Periodontics
22154
ZZ
1223P0300X
Periodontics
32052
TX
Other
Enumeration date
06/11/2013
Last updated
06/06/2022
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