Individual
DR. GARY B GRAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2099 W US HIGHWAY 50, SUITE 120, PUEBLO, CO 81008-1672
(719) 542-3595
(719) 543-5665
Mailing address
2099 W US HIGHWAY 50, SUITE 120, PUEBLO, CO 81008-1672
(719) 542-3595
(719) 543-5665
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6697
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02066975
—
CO
05
—
48952346
—
CO
Enumeration date
04/11/2007
Last updated
07/09/2007
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