Individual
DERRICK BRANDON GRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
3 W GOWEN AVE, PHILADELPHIA, PA 19119-1645
(215) 242-0670
(215) 248-3874
Mailing address
3 WEST GOWEN AVENUE, PHILADELPHIA, PA 19119
(215) 242-0670
(215) 248-3874
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
BG5342958
PA
Other
Enumeration date
11/15/2006
Last updated
07/08/2007
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